The COVID-19 pandemic response and its impact on post-corona health emergency and disaster risk management in Italy

Assessing primary healthcare disaster preparedness: a study in Northern Italy

AIM

The aim of this paper is to outline the steps taken to develop an operational checklist to assess primary healthcare (PHC) all-hazards disaster preparedness. It then describes a study testing the applicability of the checklist.

BACKGROUND

A PHC approach is an essential foundation for health emergency and disaster risk management (H-EDRM) because it can prevent and mitigate risks prior to disasters and support an effective response and recovery, thereby contributing to communities' and countries' resilience across the continuum of the disaster cycle. This approach is in line with the H-EDRM framework, published by the World Health Organization (WHO) in 2019, which emphasizes a whole-of-health system approach in disaster management and highlights the importance of integrating PHC into countries' H-EDRM. Nevertheless, literature focusing on how to practically integrate PHC into disaster management, both at the facility and at the policy level, is in its infancy. As of yet, there is no standardized, validated way to assess the specific characteristics that render PHC prepared for disasters nor a method to evaluate its role in H-EDRM.

METHODS

The checklist was developed through an iterative process that leveraged academic literature and expert consultations at different stages of the elaboration process. It was then used to assess primary care facilities in a province in Italy.

FINDINGS

The checklist offers a practical instrument for assessing and enhancing PHC disaster preparedness and for improving planning, coordination, and funding allocation. The study identified three critical areas for improvement in the province's PHC disaster preparedness. First, primary care teams should be more interdisciplinary. Second, primary care services should be more thoroughly integrated into the broader health system. Third, there is a notable lack of awareness of H-EDRM principles among PHC professionals. In the future, the checklist can be elaborated into a weighted tool to be more broadly applicable.

Primary Health Care and Disasters: Applying a "Whole-of-Health System" Approach through Reverse Triage in Mass-Casualty Management

INTRODUCTION

In 2019, the World Health Organization (WHO) published the Health Emergency and Disaster Risk Management (H-EDRM) framework detailing how effective management of disasters, including mass-casualty incidents (MCIs), can be achieved through a whole-of-health system approach where each level of the health care system is involved in all phases of the disaster cycle. In light of this, a primary health care (PHC) approach can contribute to reducing negative health outcomes of disasters, since it encompasses the critical roles that primary care services can play during crises. Hospitals can divert non-severe MCI victims to primary care services by applying reverse triage (RT), thereby preventing hospital overloading and ensuring continuity of care for those who do not require hospital services during the incident.

STUDY OBJECTIVE

This study explores the topic by reviewing the literature published on early discharge of MCI victims through RT criteria and existing referral pathways to primary care services.

METHODS

A scoping literature review was performed and a total of ten studies were analyzed.

RESULTS

The results showed that integrating primary care facilities into disaster management (DM) through the use of RT may be an effective strategy to create surge during MCIs, provided that clear referral protocols exist between hospitals and primary care services to ensure continuity of care. Furthermore, adequate training should be provided to primary care professionals to be prepared and be able to provide quality care to MCI victims.

CONCLUSION

The results of this current review can serve as groundwork upon which to design further research studies or to help devise strategies and policies for the integration of PHC in MCI management.

Exploring Italian healthcare facilities response to COVID-19 pandemic: Lessons learned from the Italian Response to COVID-19 initiative

The COVID-19 pandemic exerted an extraordinary pressure on the Italian healthcare system (Sistema Sanitario Nazionale, SSN), determining an unprecedented health crisis. In this context, a multidisciplinary non-governmental initiative called Italian Response to COVID-19 (IRC-19) was implemented from June 2020 to August 2021 to support the Italian health system through multiple activities aimed to mitigate the effects of the pandemic. The objective of this study was to shed light on the role of NGOs in supporting the SSN during the first pandemic wave by specifically exploring: (1) the main challenges experienced by Italian hospitals and out-of-hospital care facilities and (2) the nature and extent of the IRC-19 interventions specifically implemented to support healthcare facilities, to find out if and how such interventions met healthcare facilities' perceived needs at the beginning of the pandemic. We conducted a cross-sectional study using an interviewer administered 32-item questionnaire among 14 Italian healthcare facilities involved in the IRC-19 initiative. Health facilities' main challenges concerned three main areas: healthcare workers, patients, and facilities' structural changes. The IRC-19 initiative contributed to support both hospital and out-of-hospital healthcare facilities by implementing interventions for staff and patients' safety and flow management and interventions focused on the humanization of care. The support from the third sector emerged as an added value that strengthened the Italian response to the COVID-19 pandemic. This is in line with the Health-Emergency and Disaster Risk Management (H-EDRM) precepts, that call for a multisectoral and multidisciplinary collaboration for an effective disaster management.

The Fallout of Catastrophic Technogenic Emissions of Toxic Gases Can Negatively Affect Covid-19 Clinical Course

The coronavirus D-19 (Covid-19) pandemic has shaken almost every country in the world: as we stand, 6,3 million deaths from the infection have already been recorded, 167,000 and 380,000 of which are in Italy and the Russian Federation, respectively. In the first wave of the pandemic, Italy suffered an abnormally high death toll. A detailed analysis of available epidemiological data suggests that that rate was shockingly high in the Northern regions and in Lombardy, in particular, whilst in the southern region the situation was less dire. This inexplicably high mortality rate in conditions of a very well-developed health care system such as the one in Lombardy - recognized as one of the best in Italy - certainly cries for a convincing explanation. In 1976, the small city of Seveso, Lombardy, experienced a release of dioxin into the atmosphere after a massive technogenic accident. The immediate effects of the industrial disaster did not become apparent until a surge in the number of tumors in the affected population in the subsequent years. In this paper, we endeavor to prove our hypothesis that the release of dioxin was a negative cofactor that contributed to a worsening of the clinical course of COVID-19 in Lombardy.