1
|
Gandra d'Almeida A, Coopersmith CM. Disaster management - preparation and planning for acute care facilities. Curr Opin Crit Care 2024; 30:195-201. [PMID: 38690952 DOI: 10.1097/mcc.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE OF REVIEW Both human-derived and naturally-occurring disasters stress the surge capacity of health systems and acute care facilities. In this article, we review recent literature related to having a disaster plan, facility planning principles, institutional and team preparedness, the concept of surge capacity, simulation exercises and advantages and disadvantages of each. RECENT FINDINGS Evidence suggests that every institution should have a disaster plan and a dedicated team responsible for updating this plan. The disaster plan must be people-oriented and incorporate different perspectives and opinions so that all stakeholders feel included and can contribute to a joint response. Simulation exercises are fundamental for preparation so that the team functions seamlessly in uncommon times when disaster management transitions from a theoretical plan to one that is executed in real time. Notably, however, there are significantly different realities related to disaster management between countries and even within the same country or region. Unfortunately, key stakeholders such as hospital administration, board of directors and investors often do not believe they have any responsibility related to disaster management planning or response. Additionally, while a disaster plan often exists within an institution, it is frequently not well known or understood by many stakeholders. Communication, simple plans and well defined roles are some of the most important characteristics of a successful response. In extreme circumstances, adapting civilian facilities to manage high-volume warfare-related injuries may be adopted, but the consequences of this approach for routine healthcare within a system can be devastating. SUMMARY Disaster management requires careful planning with input from multiple stakeholders and a plan that is frequently updated with repeated preparation to ensure the team is ready when a disaster occurs. Close communication as well as clearly defined roles are critical to success when transitioning from preparation to activation and execution of a disaster response.
Collapse
Affiliation(s)
| | - Craig M Coopersmith
- Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Boyle TP, Mehra A, Smith NJ, Subramanian S, Leeber J, McMahon M, Green D, Perry S, Passman D, Biddinger PD, Scott B. The First Statewide Implementation of a Regional Disaster Teleconsultation System to Expand Critical Care Surge Capacity: A Case Study in Vermont. Telemed J E Health 2024; 30:1495-1498. [PMID: 38039352 PMCID: PMC11238841 DOI: 10.1089/tmj.2023.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Background: In December 2021, the Region 1 Disaster Health Response System, the state of Vermont, and the National Emergency Tele-Critical Care Network partnered to provide statewide access to disaster teleconsultations during COVID-19 surge conditions. In this case report, we describe how a disaster teleconsultation system was implemented in Vermont to provide access to temporary tele-critical care consultations during the Omicron COVID-19 surge. Methods: We measured the time from request of service to implementation and calculated descriptive statistics. Results: Seven of Vermont's 14 hospitals requested the service. Despite a technology solution capable of providing services within hours, mean time to service implementation was 27 days (interquartile range 20-41 days). Conclusions: Integration of disaster teleconsultation systems into state and local emergency management plans are needed to bring administrative start-up times in line with technical readiness.
Collapse
Affiliation(s)
- Tehnaz P Boyle
- Department of Pediatrics, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Region 1 Disaster Health Response System, Boston, Massachusetts, USA
| | - Ashley Mehra
- National Emergency Tele-Critical Care Network, Ft Detrick, Maryland, USA
- University of Cambridge, Institute of Criminology, Cambridge, United Kingdom
| | - Nathanael J Smith
- Department of Pediatrics, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sanjay Subramanian
- National Emergency Tele-Critical Care Network, Ft Detrick, Maryland, USA
| | - James Leeber
- Region 1 Disaster Health Response System, Boston, Massachusetts, USA
- Center for Disaster Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maureen McMahon
- Region 1 Disaster Health Response System, Boston, Massachusetts, USA
| | - Devon Green
- Vermont Association of Hospitals and Health Systems, Montpelier, Vermont, USA
| | - Sarah Perry
- Vermont Department of Health, Burlington, Vermont, USA
| | - Dina Passman
- National Emergency Tele-Critical Care Network, Ft Detrick, Maryland, USA
- U.S. Department of Health and Human Services, Administration for Strategic Planning and Response, Washington, District of Columbia, USA
| | - Paul D Biddinger
- Region 1 Disaster Health Response System, Boston, Massachusetts, USA
- Center for Disaster Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin Scott
- National Emergency Tele-Critical Care Network, Ft Detrick, Maryland, USA
- Department of Anesthesiology, Anschutz Health Sciences Campus, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
3
|
Uzun MB, Gülpınar G, Iqbal A. Exploring Volunteer Pharmacists' Experiences in Responding to 2023 Türkiye Earthquakes: A Qualitative Phenomenological Study. Disaster Med Public Health Prep 2024; 18:e60. [PMID: 38602096 DOI: 10.1017/dmp.2024.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE Pharmacists are vital in disaster response efforts, dispensing essential medications, managing pharmacy services, consulting, and educating survivors regarding their medications. Their contributions, however, are often underrepresented in scientific literature. This study aimed to explore the experiences of pharmacists who provided pharmacy services to meet the pharmaceutical needs of the survivors after 2 major earthquakes in Türkiye in 2023. METHODS This study adopted a phenomenological approach. Data were collected using semi-structured interviews. Purposive sampling was used to invite pharmacists who provided pharmacy services to survivors. Interview transcripts were analyzed following an inductive, reflexive thematic analysis. RESULTS In total, 15 pharmacists were interviewed. Four main overarching themes "response to the earthquake," "preparedness for the earthquake," "experiences during service delivery," and "mental and physical experiences" were developed. CONCLUSIONS From participants' experiences, it is essential to expand the clinical responsibilities of pharmacists and train them in providing wound care, administering immunization, and prescribing. Pharmacists should be integrated as essential members of disaster health teams. International health organizations, nongovernmental organizations, and governments are encouraged to work collaboratively and develop disaster management plans including pharmacists in early responders. This might help mitigate the deficiencies and overcome challenges in health-care systems to provide effective patient-centered care by health professionals and respond effectively to disasters.
Collapse
Affiliation(s)
- Mehmet Barlas Uzun
- Department of Pharmacy Management, Faculty of Gülhane Pharmacy, Sağlık Bilimleri University, Ankara, Türkiye
| | - Gizem Gülpınar
- Department of Pharmacy Management, Faculty of Pharmacy, Gazi University, Ankara, Türkiye
| | - Ayesha Iqbal
- Office of Lifelong Learning and the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| |
Collapse
|
4
|
Lichtblau M, Reimann L, Piccari L. Pulmonary vascular disease, environmental pollution, and climate change. Pulm Circ 2024; 14:e12394. [PMID: 38933180 PMCID: PMC11205889 DOI: 10.1002/pul2.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Pollution and climate change constitute a combined, grave and pervasive threat to humans and to the life-support systems on which they depend. Evidence shows a strong association between pollution and climate change on cardiovascular and respiratory diseases, and pulmonary vascular disease (PVD) is no exception. An increasing number of studies has documented the impact of environmental pollution and extreme temperatures on pulmonary circulation and the right heart, on the severity and outcomes of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (PH), on the incidence of pulmonary embolism, and the prevalence and severity of diseases associated with PH. Furthermore, the downstream consequences of climate change impair health care systems' accessibility, which could pose unique obstacles in the case of PVD patients, who require a complex and sophisticated network of health interventions. Patients, caretakers and health care professionals should thus be included in the design of policies aimed at adaptation to and mitigation of current challenges, and prevention of further climate change. The purpose of this review is to summarize the available evidence concerning the impact of environmental pollution and climate change on the pulmonary circulation, and to propose measures at the individual, healthcare and community levels directed at protecting patients with PVD.
Collapse
Affiliation(s)
- Mona Lichtblau
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lena Reimann
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lucilla Piccari
- Department of Pulmonary MedicineHospital del MarBarcelonaSpain
| |
Collapse
|
5
|
Maphosa T, Denoeud-Ndam L, Kapanda L, Khatib S, Chilikutali L, Matiya E, Munthali B, Dambe R, Chiwandira B, Wilson B, Nyirenda R, Nyirenda L, Chikwapulo B, Musopole OM, Tiam A, Katirayi L. Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi. BMC Health Serv Res 2024; 24:244. [PMID: 38408975 PMCID: PMC10897989 DOI: 10.1186/s12913-024-10700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Despite tremendous progress in antiretroviral therapy (ART) and access to ART, many patients have advanced human immunodeficiency virus (HIV) disease (AHD). Patients on AHD, whether initiating ART or providing care after disengagement, have an increased risk of morbidity and mortality. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) launched an enhanced care package using a hub-and-spoke model to optimize AHD care in Malawi. This model improves supply availability and appropriate linkage to care. We utilized a hub-and-spoke model to share health facility challenges and recommendations on the AHD package for screening and diagnosis, prophylaxis, treatment, and adherence support. METHODS This qualitative study assessed the facility-level experiences of healthcare workers (HCWs) and lay cadres (LCs) providing AHD services to patients through an intervention package. The study population included HCWs and LCs supporting HIV care at four intervention sites. Eligible study participants were recruited by trained Research Assistants with support from the health facility nurse to identify those most involved in supporting patients with AHD. A total of 32 in-depth interviews were conducted. Thematic content analysis identified recurrent themes and patterns across participants' responses. RESULTS While HCWs and LCs stated that most medications are often available at both hub and spoke sites, they reported that there are sometimes limited supplies and equipment to run samples and tests necessary to provide AHD care. More than half of the HCWs stated that AHD training sufficiently prepared them to handle AHD patients at both the hub and spoke levels. HCWs and LCs reported weaknesses in the patient referral system within the hub-and-spoke model in providing a linkage of care to facilities, specifically improper referral documentation, incorrect labeling of samples, and inconsistent availability of transportation. While HCWs felt that AHD registers were time-consuming, they remained motivated as they thought they provided better patient services. CONCLUSIONS These findings highlight the importance of offering comprehensive AHD services. The enhanced AHD program addressed weaknesses in service delivery through decentralization and provided services through a hub-and-spoke model, improved supply availability, and strengthened linkage to care. Additionally, addressing the recommendations of service providers and patients is essential to improve the health and survival of patients with AHD.
Collapse
Affiliation(s)
- Thulani Maphosa
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi.
| | | | - Lester Kapanda
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Sarah Khatib
- George Washington University, Washington, DC, USA
| | | | | | | | - Rosalia Dambe
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Brown Chiwandira
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Bilaal Wilson
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Rose Nyirenda
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | | | | | | | | | - Leila Katirayi
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| |
Collapse
|
6
|
Wiesehahn LT, Kaifie A. The impact of the 2021 flood on the outpatient care in the North Rhine region, Germany: a cross-sectional study. BMC Public Health 2024; 24:250. [PMID: 38254123 PMCID: PMC10801951 DOI: 10.1186/s12889-023-17279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/21/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND In the summer of 2021, heavy precipitation led to extreme flooding across Western Europe. In Germany, North Rhine-Westphalia and Rhineland-Palatinate were particularly affected. More than 180 people lost their lives, and over 700 were left injured and traumatized. In the North Rhine district alone, more than 120 practices were only able to operate to a limited extent or had to close their practices completely. The aim of this study was to assess the impact of the 2021 flood on the outpatient care in the North Rhine region. METHODS The cross-sectional study was conducted in January 2022 in practices affected by the flood in the North Rhine region. For this purpose, 210 affected practices were identified using a list of the Association of Statutory Health Insurance Physicians for North Rhine (KVNO) and via telephone and/or e-mail. These practices were forwarded a questionnaire that addressed, among other things, the local accessibility of the practices before and after the flood, possibilities of patient care in different premises and received support. RESULTS A total of 103 practices (49.1%) returned the completed questionnaire, of which 1/4 were general practitioners. 97% of the practices reported power failure, more than 50% water supply damage and nearly 40% the loss of patient records. 76% of the participating practices stated that they needed to close their practice at least temporarily. 30 doctors took up patient care in alternative premises. The average number of patients seen by doctors per week before the flood was 206.5. In the first week working in alternative premises, doctors saw an average of 66.2 patients (-50.3%). Especially elderly/geriatric patients and patients with disabilities were identified as particularly vulnerable in terms of access to health care after the flood. CONCLUSIONS The flood had a significant negative impact on outpatient care. We determined not only a high number of closed practices and a large decrease in patient numbers but also differences in patient care assessment depending on the type of alternative premises. To address outpatient care disruptions after extreme weather events more effectively, appropriate measures should be implemented pre-emptively.
Collapse
Affiliation(s)
- Luca Theresa Wiesehahn
- Institute for Occupational, Social, and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Andrea Kaifie
- Institute for Occupational, Social, and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| |
Collapse
|
7
|
Khirekar J, Badge A, Bandre GR, Shahu S. Disaster Preparedness in Hospitals. Cureus 2023; 15:e50073. [PMID: 38192940 PMCID: PMC10771935 DOI: 10.7759/cureus.50073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
Disaster preparedness in hospitals is a critical global concern that involves proactive measures to mitigate the impact of natural or artificial disasters. The review emphasizes the role of organizations such as India's National Disaster Management Authority in the development of response strategies. Hospitals face challenges in protecting facilities and healthcare workers during disasters, highlighting the need for effective training, equipment, and communication access. Differentiating disasters into natural, technological, and artificial types showcases the varied challenges each presents. Key challenges include resource allocation, interoperability of the communication system, evacuation strategies, and ethical considerations. Essential strategies include risk assessment, staff training, communication, and collaboration with external partners. Hospital disaster preparedness requires a comprehensive approach that involves strategies, training, and community participation to ensure safety during emergencies.
Collapse
Affiliation(s)
- Janhavi Khirekar
- Hospital Administration, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
| | - Ankit Badge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
| | - Gulshan R Bandre
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Wardha, IND
| | - Shivani Shahu
- Hospital Administration, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
| |
Collapse
|
8
|
Lokmic-Tomkins Z, Block LJ, Davies S, Reid L, Ronquillo CE, von Gerich H, Peltonen LM. Evaluating the representation of disaster hazards in SNOMED CT: gaps and opportunities. J Am Med Inform Assoc 2023; 30:1762-1772. [PMID: 37558235 PMCID: PMC10586035 DOI: 10.1093/jamia/ocad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE Climate change, an underlying risk driver of natural disasters, threatens the environmental sustainability, planetary health, and sustainable development goals. Incorporating disaster-related health impacts into electronic health records helps to comprehend their impact on populations, clinicians, and healthcare systems. This study aims to: (1) map the United Nations Office for Disaster Risk Reduction and International Science Council (UNDRR-ISC) Hazard Information Profiles to SNOMED CT International, a clinical terminology used by clinicians, to manage patients and provide healthcare services; and (2) to determine the extent of clinical terminologies available to capture disaster-related events. MATERIALS AND METHODS Concepts related to disasters were extracted from the UNDRR-ISC's Hazard Information Profiles and mapped to a health terminology using a procedural framework for standardized clinical terminology mapping. The mapping process involved evaluating candidate matches and creating a final list of matches to determine concept coverage. RESULTS A total of 226 disaster hazard concepts were identified to adversely impact human health. Chemical and biological disaster hazard concepts had better representation than meteorological, hydrological, extraterrestrial, geohazards, environmental, technical, and societal hazard concepts in SNOMED CT. Heatwave, drought, and geographically unique disaster hazards were not found in SNOMED CT. CONCLUSION To enhance clinical reporting of disaster hazards and climate-sensitive health outcomes, the poorly represented and missing concepts in SNOMED CT must be included. Documenting the impacts of climate change on public health using standardized clinical terminology provides the necessary real time data to capture climate-sensitive outcomes. These data are crucial for building climate-resilient healthcare systems, enhanced public health disaster responses and workflows, tracking individual health outcomes, supporting disaster risk reduction modeling, and aiding in disaster preparedness, response, and recovery efforts.
Collapse
Affiliation(s)
- Zerina Lokmic-Tomkins
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Lorraine J Block
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shauna Davies
- Faculty of Nursing, University of Regina, Regina, Saskatchewan, Canada
| | - Lisa Reid
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | | | - Hanna von Gerich
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Laura-Maria Peltonen
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| |
Collapse
|