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PubMed2005

The preparedness of schools to respond to emergencies in children: a national survey of school nurses.

OBJECTIVES: Because children spend a significant proportion of their day in school, pediatric emergencies such as the exacerbation of medical conditions, behavioral crises, and accidental/intentional injuries are likely to occur. Recently, both the American Academy of Pediatrics and the American Heart Association have published guidelines stressing the need for school leaders to establish emergency-response plans to deal with life-threatening medical emergencies in children. The goals include developing an efficient and effective campus-wide communication system for each school with local emergency medical services (EMS); establishing and practicing a medical emergency-response plan (MERP) involving school nurses, physicians, athletic trainers, and the EMS system; identifying students at risk for life-threatening emergencies and ensuring the presence of individual emergency care plans; training staff and students in first aid and cardiopulmonary resuscitation (CPR); equipping the school for potential life-threatening emergencies; and implementing lay rescuer automated external defibrillator (AED) programs. The objective of this study was to use published guidelines by the American Academy of Pediatrics and the American Heart Association to examine the preparedness of schools to respond to pediatric emergencies, including those involving children with special care needs, and potential mass disasters. METHODS: A 2-part questionnaire was mailed to 1000 randomly selected members of the National Association of School Nurses. The first part included 20 questions focusing on: (1) the clinical background of the school nurse (highest level of education, years practicing as a school health provider, CPR training); (2) demographic features of the school (student attendance, grades represented, inner-city or rural/suburban setting, private or public funding, presence of children with special needs); (3) self-reported frequency of medical and psychiatric emergencies (most common reported school emergencies encountered over the past school year, weekly number of visits to school nurses, annual number of "life-threatening" emergencies requiring activation of EMS); and (4) the preparedness of schools to manage life-threatening emergencies (presence of an MERP, presence of emergency care plans for asthmatics, diabetics, and children with special needs, presence of a school nurse during all school hours, CPR training of staff and students, availability of athletic trainers during all athletic events, presence of an MERP for potential mass disasters). The second part included 10 clinical scenarios measuring the availability of emergency equipment and the confidence level of the school nurse to manage potential life-threatening emergencies. RESULTS: Of the 675 questionnaires returned, 573 were eligible for analysis. A majority of responses were from registered nurses who have been practicing for >5 years in a rural or suburban setting. The most common reported school emergencies were extremity sprains and shortness of breath. Sixty-eight percent (391 of 573 [95% confidence interval (CI): 64-72%]) of school nurses have managed a life-threatening emergency requiring EMS activation during the past school year. Eighty-six percent (95% CI: 84-90%) of schools have an MERP, although 35% (95% CI: 31-39%) of schools do not practice the plan. Thirteen percent (95% CI: 10-16%) of schools do not identify authorized personnel to make emergency medical decisions. When stratified by mean student attendance, school setting, and funding classification, schools with and without an MERP did not differ significantly. Of the 205 schools that do not have a school nurse present on campus during all school hours, 17% (95% CI: 12-23%) do not have an MERP, 17% (95% CI: 12-23%) do not identify an authorized person to make medical decisions when faced with a life-threatening emergency, and 72% (95% CI: 65-78%) do not have an effective campus-wide communication system. CPR training is offered to 76% (95% CI: 70-81%) of the teachers, 68% (95% CI: 61-74%) of the administrative staff, and 28% (95% CI: 22-35%) of the students. School nurses reported the availability of a bronchodilator meter-dosed inhaler (78% [95% CI: 74-81%]), AED (32% [95% CI: 28-36%]), and epinephrine autoinjector (76% [95% CI: 68-79%]) in their school. When stratified by inner-city and rural/suburban school setting, the availability of emergency equipment did not differ significantly except for the availability of an oxygen source, which was higher in rural/suburban schools (15% vs 5%). School-nurse responders self-reported more confidence in managing respiratory distress, airway obstruction, profuse bleeding/extremity fracture, anaphylaxis, and shock in a diabetic child and comparatively less confidence in managing cardiac arrest, overdose, seizure, heat illness, and head injury. When analyzing schools with at least 1 child with special care needs, 90% (95% CI: 86-93%) have an MERP, 64% (95% CI: 58-69%) have a nurse available during all school hours, and 32% (95% CI: 27-38%) have an efficient and effective campus-wide communication system linked with EMS. There are no identified authorized personnel to make medical decisions when the school nurse is not present on campus in 12% (95% CI: 9-16%) of the schools with children with special care needs. When analyzing the confidence level of school nurses to respond to common potential life-threatening emergencies in children with special care needs, 67% (95% CI: 61-72%) of school nurses felt confident in managing seizures, 88% (95% CI: 84-91%) felt confident in managing respiratory distress, and 83% (95% CI: 78-87%) felt confident in managing airway obstruction. School nurses reported having the following emergency equipment available in the event of an emergency in a child with special care needs: glucose source (94% [95% CI: 91-96%]), bronchodilator (79% [95% CI: 74-83%]), suction (22% [95% CI: 18-27%]), bag-valve-mask device (16% [95% CI: 12-21%]), and oxygen (12% [95% CI: 9-16%]). An MERP designed specifically for potential mass disasters was present in 418 (74%) of 573 schools (95% CI: 70-77%). When stratified by mean student attendance, school setting, and funding classification, schools with and without an MERP for mass disasters did not differ significantly. CONCLUSIONS: Although schools are in compliance with many of the recommendations for emergency preparedness, specific areas for improvement include practicing the MERP several times per year, linking all areas of the school directly with EMS, identifying authorized personnel to make emergency medical decisions, and increasing the availability of AED in schools. Efforts should be made to increase the education of school nurses in the assessment and management of life-threatening emergencies for which they have less confidence, particularly cardiac arrest, overdose, seizures, heat illness, and head injury.

Adolescent↗

PubMed1999

Dealing with animal disease emergencies in Africa: prevention and preparedness.

Emergency preparedness planning for animal diseases is a relatively new concept that is only now being applied in Africa. Information can be drawn from numerous recent disease epidemics involving rinderpest, contagious bovine pleuropneumonia (CBPP) and Rift Valley fever. These examples clearly demonstrate the shortcomings and value of effective early warning with ensured early reaction in the control of transboundary animal disease events. In concert, the Food and Agriculture Organization (FAO), through the Emergency Prevention-System for Transboundary Animal and Plant Pests and Diseases (EMPRES), and Organisation of African Unity/Inter-African Bureau for Animal Resources (OAU/IBAR), through the European Commission-funded Pan-African Rinderpest Campaign (PARC), have been actively promoting the concepts and application of emergency preparedness planning and should continue to do so under the proposed successor of PARC, namely: the Pan-African Programme for the Control of Epizootics (PACE). The potential partnership between the normative function of the FAO in developing and promoting emergency preparedness and the implementation of improved national and regional disease surveillance by PACE and other partners could witness the commencement of more progressive control of epidemic diseases in Africa and greater self-reliance by African countries in coping with transboundary animal disease emergencies.

Africa↗

PubMed2004

The pitfalls of bioterrorism preparedness: the anthrax and smallpox experiences.

Bioterrorism preparedness programs have contributed to death, illness, and waste of public health resources without evidence of benefit. Several deaths and many serious illnesses have resulted from the smallpox vaccination program; yet there is no clear evidence that a threat of smallpox exposure ever existed. The anthrax spores released in 2001 have been linked to secret US military laboratories-the resultant illnesses and deaths might not have occurred if those laboratories were not in operation. The present expansion of bioterrorism preparedness programs will continue to squander health resources, increase the dangers of accidental or purposeful release of dangerous pathogens, and further undermine efforts to enforce international treaties to ban biological and chemical weapons. The public health community should acknowledge the substantial harm that bioterrorism preparedness has already caused and develop mechanisms to increase our public health resources and to allocate them to address the world's real health needs.

Anthrax↗

PubMed2004

[Determinant factors of community-based disaster preparedness: a case study of flood prone area].

This study examined the determinants of willingness to participate in a community-based disaster preparedness scheme. The theory of reasoned action (Ajzen & Fishbein, 1977, 1980; Fishbein & Ajzen, 1975) was applied as a basic model and was complemented by the factor of concern about disaster. A structural equation modeling was performed to validate this model. The hypothetical model was supported for the data from the residents (N = 3 036) of an area with a high risk of flood damage. It was clarified that the subjective norm and concern about flood positively contributed to the intention of participating in a community-based disaster preparedness scheme. The perceived cost of preparedness was the inhibitory factor of participating in such a scheme.

Adult↗

PubMedDate not supplied

The role of health sectors in disaster preparedness. Floods in southeastern China, 1991.

Disasters, whether natural or man-made, usually are unpredictable. Efforts to reduce morbidity and mortality from a disaster should be put forth before it occurs. A brief survey is presented of the worst flood to occur in a hundred years that affected eight provinces in Southeast China. The disaster preparedness and response for Anhui Province, the hardest hit area, is summarized. The disaster preparedness was comprehensive, and cooperation was achieved among various specialties: military forces; firefighters; civil engineers; mechanics; police; provincial governors; the medical sectors; and so forth. Among these groups, the role of medical sectors was of great importance in reducing disease that would have resulted from such a disaster. The measures undertaken by the medical sectors included development of an organization to reduce the impact of disaster; training of medical personnel in techniques of rescue and in treatment of victims in disaster areas; development of a plan to assist the leadership in decision-making and establishing support for disaster preparedness; and maintaining sufficient capacity in general hospitals for the admission of victims from disaster areas.

China↗

PubMed1999

Animal health emergencies: prevention and preparedness in Asia.

Besides response and recovery, prevention and preparedness are the two critical components of any contingency plan. The author discusses the various elements which must be present in the prevention and preparedness plan of countries in Asia. As the continent has such diverse peoples and veterinary infrastructures, the actual plan may vary from one country to another, but must incorporate those elements which are crucial to ensure the success of the preparedness plan.

Animal Diseases↗

PubMed1987

Developing a hospital emergency preparedness program.

The emergency preparedness program is not a static entity that only needs to be taken off the shelf and looked at once or twice a year. The various components of the program require that it be a daily part of the hospital's routine. Only by becoming a part of the everyday operation of the hospital can the full benefits of an emergency preparedness program be realized in an actual disaster. A part of the recovery activities after a hospital experiences an actual disaster should be to examine all phases of the emergency preparedness program. The program should be viewed as if it were being designed from scratch. Time should be taken to identify any areas of weakness, develop a plan for making the necessary corrections, and then implement those corrections.

Accreditation↗

PubMedDate not supplied

Psychiatric disorders among bereaved persons: the role of perceived circumstances of death and preparedness for death.

The authors evaluated the association between bereaved persons' perceptions of the death (e.g., extent of suffering) and preparedness for the death and psychiatric disorders. The sample was 122 persons who received a baseline interview at approximately 4 months post-loss and a follow-up interview 5 months later, at approximately 9 months post-loss. In addition to bivariate associations between perceptions of circumstances of death and psychiatric outcomes, authors used multivariate logistic-regression models to determine the extent to which perceptions of the death were associated with the likelihood of psychiatric disorders in survivors at baseline and follow-up. Perception of the death as more violent was associated with major depressive disorder at baseline. Perception of lack of preparedness for the death was associated with complicated grief at baseline and at follow-up. These preliminary results suggest that perceptions of the death and feelings of lack of preparedness for it may be indicators of persons at risk of developing psychiatric morbidity secondary to bereavement. Further studies are needed to confirm these findings.

Aged↗

PubMed2002

Preparedness on the frontline: what's law got to do with it?

The article provides an overview of current work toward identifying core competencies for public health emergency and bio-terrorism response, including law-related competencies. It demonstrates how competency sets are interrelated and how they provide a framework for developing preparedness training for public health leaders, public health and health care professionals, law enforcement, public health attorneys, and others. The health and safety of America's communities hinge on the nation's public health workforce--the estimated 448,254 public health professionals and 3 million related workforce professionals who form the expanded public health system that protects us during times of national crisis and in our daily lives. The response capacity of our health agencies and communities and their ability to respond effectively will be unpredictable without adequate training. Education in the core competencies in emergency preparedness and bio-terrorism response is essential. Preparedness at the front-line means that public health leaders and administrators must be able to communicate information, roles, capacities, and legal authorities to all emergency response partners during planning, drills, and actual emergencies. Each public health worker must be able to describe his or her communication role in emergency response within the agency, with the media, and with the general public. Law enforcement and state government representatives must understand the legal powers of their agencies and of public health agencies for coordinated response, mitigation, and recovery efforts in a public health emergency event.

Biological Warfare↗

PubMed2003

Bioterrorism preparedness.

The Connecticut Department of Public Health (DPH) entered into a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to establish public health preparedness and a response plan for bioterrorism. With funds from the CDC and an additional grant from the Health Resources and Services Administration (HRSA), the DPH designated Hartford Hospital as one of two Centers of Excellence that will coordinate and manage a statewide system for bioterrorism preparedness. This paper reviews the progress that Hartford Hospital has made in meeting this challenge. Highlighted are the development of a Web application to use for statewide preparedness and response, and the preparation for a smallpox vaccination program at Hartford Hospital.

Bioterrorism↗

PubMed2004

Predoctoral dental school curriculum for catastrophe preparedness.

Preparing for catastrophic events, both human-made and natural, is in the national interest and has become a priority since catastrophic events in Oklahoma City, Washington, DC, and New York City. Dentists are a large source of non-physician health manpower that could contribute to the public welfare during catastrophic events that require additional public health human resources. Dentists, by virtue of their education, understand biomedical concepts and have patient care skills that can be directly applied during a catastrophic event. Dentists also can provide training for other types of health care workers and can supervise these individuals. In this article, we propose that dentistry can make a significant contribution as part of a national response before, during, and after a catastrophic event or at the time of a public health emergency. We describe the potential collaboration among a dental school, city and state health departments, law enforcement, the military, and others to develop a curriculum in catastrophe preparedness. Then we describe one dental school's effort to build a catastrophe preparedness curriculum for our students. The competencies, goals and objectives, and sources of content for this catastrophe preparedness curriculum are described as well as suggestions for sequencing instruction.

Civil Defense↗

PubMed2004

Perspectives of rural hospitals on bioterrorism preparedness planning.

Even the smallest, most isolated rural hospitals are now required to have bioterrorism preparedness plans. From the perspective of many rural hospitals, however, there is a disparity between Federal expectations and the realities of small hospitals operating in geographically isolated communities. As part of an effort to better understand how to close this gap, the Walsh Center for Rural Health Analysis convened a panel of representatives of rural hospitals who are responsible for bioterrorism preparedness in their hospitals. Perspectives of rural hospitals on various aspects of preparedness were discussed, in terms of workforce and training, physical capacity and supplies, communication, and coordination with other entities. All of the participants noted the tremendous progress that has been made in the past two years, but also the distance they each need to go. Some of the issues raised by the panelists included the dual benefit of efforts to increase capacity at rural hospitals, the inapplicability of many federal guidelines and directives for small hospitals because of size and less sophisticated infrastructure, the burden of geographic isolation relative to obtaining training and information, and the fragmentation of funding and directives at both the state and federal levels.

Bioterrorism↗

PubMedDate not supplied

After 9/11: priority focus areas for bioterrorism preparedness in hospitals.

Following the terrorist attacks of September 11, 2001, bioterrorism preparedness was a priority in hospitals, but it did not remain a priority. As a result, hospitals are still unprepared to deal with the effects of a bioterrorist attack. The government has provided initial funding to state and local governments for bioterrorism preparedness; however, much of this money has yet to reach hospitals. With the inadequate funding available to hospitals, four initial measures must be focused on. These focus areas are community involvement, hospital staff education, information technology and disease surveillance improvement, and additional equipment and staff acquisition. Hospitals should also make bioterrorism-preparedness planning a regional effort.

Bioterrorism↗

PubMed2004

Terrorism preparedness training for occupational health professionals.

OBJECTIVE: The objective of this study was to assess occupational health professionals' terrorism preparedness and perceptions of worksite readiness. METHODS: Questionnaire data were collected at the conclusion of an educational workshop on disaster response. RESULTS: Participants reported increased confidence in clinical skills and the ability to avoid exposure while providing care to victims of terrorist attacks as a result of the workshop. Fewer than one third (32%) of participants reported that their employer was prepared for a bioterrorism attack, and a large percentage (75%) reported feeling unprepared to provide mental health counseling after a terrorist attack. CONCLUSIONS: Relatively brief training in terrorism preparedness can increase the confidence of occupational health professionals in their ability to respond to terrorism. Adequate preparedness for the broad range of potential terrorist events may require much more intensive training than is currently being provided to occupational health professionals.

Attitude of Health Personnel↗

PubMed2005

Preparedness progress: update on Minnesota hospitals.

Since 2002, all states have received federal funds for disaster preparedness through Health Resources and Services Administration (HRSA) Bioterrorism Hospital Preparedness Program grants. Minnesota has received dollar 19.4 million, which has been spent to improve communications and coordination among hospitals and emergency providers, purchase equipment and medications, and train staff. The Minnesota Department of Health, which administers the funds, recently assessed the state's level of preparedness, finding that the state is well-prepared for smaller events such as a chemical incident or a limited outbreak of an infectious disease. A catastrophic event such as pandemic influenza would likely overwhelm the state's systems and providers.

Disaster Planning↗

PubMedDate not supplied

Medical preparedness against chemical and biological incidents for the NATO Summit in Istanbul and lessons learned.

INTRODUCTION: During the 2004 North Atlantic Treaty Organization (NATO) Summit, essential counter-measures, including medical preparedness, were taken to cope with any suspected terrorist case or events including the use of chemical or biological (CB) weapons. The Summit was held in Istanbul, a city that bridges two continents, and involved the participation of many Heads of State, Prime Ministers, and Defense Ministers from 26 NATO countries. METHODS: First responders, including medical Chemical, Biological, Radiological, and Nuclear (CBRN) teams, received special training. Essential equipment, including drugs, antidotes, detectors, etc., was provided and stock-piled. Medical authorities augmented the capacity for identifying and controlling the injuries and any emerging CB incident through the set-up of decontamination units and the procurement of medical devices, antidotes, drugs, and personal protective suits. Additionally, a small part of the recently established NATO-CBRN battalion was welcomed to the Summit and was prepared to perform detection and identification of the agent found in suspicious appearing samples. RESULTS: Although no CB incident was reported during the Summit, extensive experience was gained with respect to medical preparedness against CB terrorism. Sampling, detection, and analysis of toxic materials were taken into account in the medical management. Much laboratory-related work was conducted in the following time period. The laboratory work involved the standardization of sampling and transportation procedures, development of both mobile and reference laboratories, and performing research activities aimed to make the CB analysis more efficient. Although the training of the medical staff was advanced, training should be continuous and supported with educational programs, conferences, meetings, and tabletop and hospital medical exercises throughout the country. CONCLUSION: Multidisciplinary cooperation, training, and preparedness should be provided to basic medical care units and centers as part of the medical planning aimed at perfect detection and surveillance, laboratory analysis, and emergency response.

Bioterrorism↗

PubMed1979

First-aid preparedness in small workplaces with special reference to occupational health services.

First-aid preparedness was surveyed in 163 small firms employing 2,400 persons. Although 11% of the employees had received first-aid training, half of the firms lacked first-aiders. Only one-fourth of the first-aid kits were equipped according to instructions. Checking and maintenance of the equipment, as well as information about first aid at the place of work, were generally inadequate. Instructions were commonly lacking for the safe use of chemical substances. Only 9% of the firms fully complied with the requirements for optimum first-aid preparedness. Employers at small firms seem not to be sufficiently aware of their liabilities with regard to first aid. Yet, most of the faults and defects could be corrected by means of arrangements within the firms once the instructions were better known. During their visits to places of work occupational health personnel should inspect the first-aid preparedness and advise the employer on first-aid requirements. In addition the expertise of the insurance company, the local Red Cross or the regional institute of occupational health may be utilized.

Finland↗

PubMedDate not supplied

Community perception about disaster preparedness and response programme in four states of India.

It is well felt that community participation, local planning, development of self reliance and manpower resource within the community itself can strengthen the effort of disaster preparedness and response. The present study was intended to bring out the salient features about perception and opinion of community leaders and community members about existing preparedness programme and appropriateness of mitigatory exercise against flood disaster in four eastern states of India viz. West Bengal, Bihar, Assam and Orissa. Many snags at the implementation level, in terms of co-ordination, directives, logistics and knowledge gap were noted, which should be dealt with due care for successful disaster preparedness programme.

Community Participation↗