Are We Ready for Mass Fatality Incidents? Preparedness of the US Mass Fatality Infrastructure

Mass fatality and disaster response preparedness across medical examiner and coroner offices in the United States

With the rise of mass fatalities and disasters, access to mass fatality and disaster planning trainings and resources available to medical examiners and coroners (MECs) in the United States should be reviewed. This paper provides a necessary update on the extent of access to these resources by analyzing data from the 2018 Census for Medical Examiner and Coroner Offices (CMEC). Results show that a high percentage of respondents have access to mass fatality and disaster planning trainings/resources; however, the access is disproportionate. Respondents in the Midwest and South-and those with smaller populations-have less access to resources, while agencies with larger budgets and more full-time staff have more access to resources. This paper discusses potential contributing factors for these disparities, but the data only begin to elucidate gaps in access to mass fatality and disaster planning trainings/resources for MECs and where further research should be conducted.

Construction of COVID-19 Epidemic Prevention and Control and Public Health Emergency Response System Based on Discrete Stochastic Mathematical Model

This research was aimed at exploring the construction and evaluation method of the comprehensive emergency response system for public health emergencies under the COVID-19 (coronavirus disease 2019) epidemic situation based on discrete stochastic mathematical model. The response of the Centers for Disease Control and Prevention (CDCP) of Taiyuan city in the COVID-19 epidemic situation was taken as an example. A new discrete stochastic COVID-19 epidemic spread mathematical model which integrated public health intervention and input cases was proposed. The model was parameterized by multisource data, and the impact of different flow patterns on the risk of secondary outbreak was analyzed. The advantages and disadvantages of its emergency system construction were analyzed. Additionally, the improvement measures and suggestions for the existing problems were proposed. Results suggested that there was only one specialized disease prevention and control institution in Taiyuan, and there were only 11 centers for disease prevention and control, accounting for 6.2% (11/177) of the total in Shanxi Province. Through the analysis, it was found that the current public health emergency response system in Taiyuan city had imperfect management coordination mechanism, incomplete plan type, serious shortage of public health personnel, poor information communication efficiency, insufficient early warning efficiency of the epidemic detection system, and weak logistics material security links. Therefore, it was proposed to establish a sound coordination system of emergency health management and vigorously promote the construction of emergency health management institutions. Thus, a public health emergency management system integrating management coordination system, plan system, emergency team building system, material reserve management, and other functions was formed. The application of discrete stochastic mathematical model suggests that intermittent population flow and effective isolation of infected people in transient population can effectively reduce the risk of secondary outbreak. The system analysis here also provides theoretical basis for improving the construction of public health emergency response system in Taiyuan.

Staffing in a Level 1 Trauma Center: Quantifying Capacity for Preparedness

OBJECTIVE

We sought to determine who is involved in the care of a trauma patient.

METHODS

We recorded hospital personnel involved in 24 adult Priority 1 trauma patient admissions for 12 h or until patient demise. Hospital personnel were delineated by professional background and role.

RESULTS

We cataloged 19 males and 5 females with a median age of 50-y-old (interquartile range [IQR], 35.5-67.5). The average number of hospital personnel involved was 79.71 (standard deviation, 17.62; standard error 3.6). A median of 51.2% (IQR, 43.4%-59.8%) of personnel were first involved within hour 1. More personnel were involved in direct versus indirect care (median 54.5 [IQR, 47.5-67.0] vs 25.0 [IQR, 22.0-30.5]; P < 0.0001). Median number of health-care professionals and auxiliary staff were 74.5 (IQR, 63.5-90.5) and 6.0 (IQR, 5.0-7.0), respectively. More personnel were first involved in hospital locations external to the emergency department (median, 53.0 [IQR, 41.5-63.0] vs 27.5 [IQR, 24.0-30.0]; P < 0.0001). No differences existed in total personnel by Injury Severity Score (P = 0.1266), day (P = 0.7270), or time of admission (P = 0.2098).

CONCLUSIONS

A large number of hospital personnel with varying job responsibilities respond to severe trauma. These data may guide hospital staffing and disaster preparedness policies.

Managing Mass Fatalities during COVID-19: Lessons for Promoting Community Resilience during Global Pandemics

In the United States and around the world, COVID-19 represents a mass fatality incident, as there are more bodies than can be handled using existing resources. Although the management and disposition of bodies is distressing and heartrending, it is a task that local, state, and federal governments must plan for and respond to collaboratively with the private sector and faith-based community. When mass fatalities are mismanaged, there are grave emotional and mental health consequences that can delay recovery and undermine community resilience. Using insights from one author's mass fatality management research during the 2010 Haiti earthquake, this Viewpoint essay explores how mass fatalities are being managed in response to COVID-19. Based on the researcher's findings a decade ago, it is apparent that many lessons have not been learned. The essay concludes by providing governments with practical lessons on how to manage mass fatalities to facilitate and promote community resilience.

Hospital Operation During a Disaster - Hospital Multi-Component Emergency Center (HMCEC)

A hospital's operating modes can be divided into three main levels of operation: routine, mass-casualty, and interim states that require procedures and resources beyond the routine capacity.Regardless of the nature of the event and the needs, the medical staff has to be prepared for a sudden increase in demand for service that could overwhelm the functional capacity and safety standards of the hospital.In any sort of an emergency event, the hospital has to fulfill two goals: First is to be able to sustain itself against the sudden rise in demand for medical support; the aid given depends on the nature of the disaster. The second goal is to continue supporting the essential routine duties for patients already hospitalized and for others arriving at the hospital regardless of the disaster.The aim of this paper is to describe the principles and the methods for hospital operation in case of a disaster-level event. The paper describes the structure and methods for handling prolonged disaster-level events and the adjustments that can be made in the case of lower intensity events.

A Productive Proposed Search Syntax for Health Disaster Preparedness Research

Objective:

To find a proper search strategy to do a systematic review related to preparedness for disasters.

Methods:

MeSH and Emtree terms were searched to detect synonyms for two main search terms “disaster” and “preparedness”. Expert opinion on the synonyms was examined applying a Google form. The adopted syntax was searched in PubMed and results were sifted. Hand searching in two top key journals was done and sensitivity was calculated.

Results:

Out of 1120 articles, 122 were included. In PDM journal, 10 articles were included by hand searching, out of which 5 were not spotted in PubMed search with the proposed syntax. In DMPHP journal, 13 publications were included, with 5 not found in PubMed search. Because of human error in hand searching 2 articles were added.

Conclusion:

The proposed syntax in this study achieves a sensitivity of search of 0.6 in PubMed which could be quite applicable for researchers. Moreover, in case only MeSH or Emtree terms were applied in search strategy or where hand searching was not performed, there were a number of articles missed.

A Productive Proposed Search Syntax for Health Disaster Preparedness Research

Objective

To find a proper search strategy to do a systematic review related to preparedness for disasters.

Methods

MeSH and Emtree terms were searched to detect synonyms for two main search terms "disaster" and "preparedness". Expert opinion on the synonyms was examined applying a Google form. The adopted syntax was searched in PubMed and results were sifted. Hand searching in two top key journals was done and sensitivity was calculated.

Results

Out of 1120 articles, 122 were included. In PDM journal, 10 articles were included by hand searching, out of which 5 were not spotted in PubMed search with the proposed syntax. In DMPHP journal, 13 publications were included, with 5 not found in PubMed search. Because of human error in hand searching 2 articles were added.

Conclusion

The proposed syntax in this study achieves a sensitivity of search of 0.6 in PubMed which could be quite applicable for researchers. Moreover, in case only MeSH or Emtree terms were applied in search strategy or where hand searching was not performed, there were a number of articles missed.

Mass-Fatality Incident Preparedness Among Faith-Based Organizations

Introduction Members of faith-based organizations (FBOs) are in a unique position to provide support and services to their local communities during disasters. Because of their close community ties and well-established trust, they can play an especially critical role in helping communities heal in the aftermath of a mass-fatality incident (MFI). Faith-based organizations are considered an important disaster resource and partner under the National Response Plan (NRP) and National Response Framework; however, their level of preparedness and response capabilities with respect to MFIs has never been evaluated. The purpose of this study was threefold: (1) to develop appropriate measures of preparedness for this sector; (2) to assess MFI preparedness among United States FBOs; and (3) to identify key factors associated with MFI preparedness. Problem New metrics for MFI preparedness, comprised of three domains (organizational capabilities, operational capabilities, and resource sharing partnerships), were developed and tested in a national convenience sample of FBO members.

METHODS

Data were collected using an online anonymous survey that was distributed through two major, national faith-based associations and social media during a 6-week period in 2014. Descriptive, bivariate, and correlational analyses were conducted.

RESULTS

One hundred twenty-four respondents completed the online survey. More than one-half of the FBOs had responded to MFIs in the previous five years. Only 20% of respondents thought that roughly three-quarters of FBO clergy would be able to respond to MFIs, with or without hazardous contamination. A higher proportion (45%) thought that most FBO clergy would be willing to respond, but only 37% thought they would be willing if hazardous contamination was involved. Almost all respondents reported that their FBO was capable of providing emotional care and grief counseling in response to MFIs. Resource sharing partnerships were typically in place with other voluntary organizations (73%) and less likely with local death care sector organizations (27%) or Departments of Health (DOHs; 32%).

CONCLUSIONS

The study suggests improvements are needed in terms of staff training in general, and specifically, drills with planning partners are needed. Greater cooperation and inclusion of FBOs in national planning and training will likely benefit overall MFI preparedness in the US. Zhi Q , Merrill JA , Gershon RR . Mass-fatality incident preparedness among faith-based organizations. Prehosp Disaster Med. 2017;32(6):596-603.

Self-reported Preparedness to Respond to Mass Fatality Incidents in 38 State Health Departments

CONTEXT

Public health departments play an important role in the preparation and response to mass fatality incidents (MFIs).

OBJECTIVE

To describe MFI response capabilities of US state health departments.

DESIGN

The data are part of a multisector cross-sectional study aimed at 5 sectors that comprise the US mass fatality infrastructure. Data were collected over a 6-week period via a self-administered, anonymous Web-based survey.

SETTING

In 2014, a link to the survey was distributed via e-mail to health departments in 50 states and the District of Columbia.

PARTICIPANTS

State health department representatives responsible for their state's MFI plans.

MEASURES

Preparedness was assessed using 3 newly developed metrics: organizational capabilities (n = 19 items); operational capabilities (n = 19 items); and resource-sharing capabilities (n = 13 items).

RESULTS

Response rate was 75% (n = 38). Among 38 responses, 37 rated their workplace moderately or well prepared; 45% reported MFI training, but only 30% reported training on MFI with hazardous contaminants; 58% estimated high levels of staff willingness to respond, but that dropped to 40% if MFIs involved hazardous contaminants; and 84% reported a need for more training. On average, 76% of operational capabilities were present. Resource sharing was most prevalent with state Office of Emergency Management but less evident with faith-based organizations and agencies within the medical examiner sector.

CONCLUSION

Overall response capability was adequate, with gaps found in capabilities where public health shares responsibility with other sectors. Collaborative training with other sectors is critical to ensure optimal response to future MFIs, but recent funding cuts in public health preparedness may adversely impact this critical preparedness element. In order for the sector to effectively meet its public health MFI responsibilities as delineated in the National Response Framework, resources to support training and other elements of preparedness must be maintained.