Best Practices for Implementation of an Employee Health COVID-19 Vaccine Clinic-A Model for Future Pandemic Preparedness

OBJECTIVES

The aims of the study are to determine best practices from two large-scale, academic medical centers' employee coronavirus 2019 (COVID-19) vaccination clinics and to apply them to create scalable modules for rapid administration of 10,000 vaccinations.

METHODS

The weekly number of COVID-19 vaccine doses administered was captured. Processes were compared to determine best practices, which informed the scalable financial model.

RESULTS

Within the first 3 months, more than 60,000 COVID-19 vaccine doses were administered, and 70% of employees were fully vaccinated in 4 months with more than 95% by the vaccine mandate deadline. The estimated cost of delivering one dose was $29.95 ($299,505/10,000) compared with $35-$39 per dose when delivered by an on-site retail pharmacy.

CONCLUSIONS

Successful, safe, and rapid delivery of more than 60,000 COVID-19 vaccine doses in 3 months is practical and scalable. Learnings go beyond COVID-19 and can be applied to future outbreaks/pandemics.

COVID-19 Contingency Planning Among Radiologic Science Programs

PURPOSE

To examine radiologic science programs' contingency planning related to the COVID-19 pandemic.

METHODS

Using a mixed-methods approach, educators in magnetic resonance, medical dosimetry, radiation therapy, and radiography programs were surveyed to identify curricular changes, policy implementation, and financial implications related to pandemic recovery efforts. Quantitative data were summarized using descriptive statistics and percentages. Thematic analyses were performed on the qualitative responses.

RESULTS

Continued curricular changes involved using technology to teach in the online environment and ensuring the safety and protection of students during clinical rotations. Institutional policies implemented because of the pandemic included social distancing guidelines, mask requirements, and availability of vaccine. The greatest financial implication witnessed among the sample of educators at their respective institutions was the halting of employer-related travel. Faced with the spontaneous shift to online learning while not being equipped with the appropriate training, most of the educator participants experienced COVID-19 fatigue and burnout related to teaching online.

DISCUSSION

Social distancing guidelines make it difficult for large classes to meet in person, so virtual lectures using video conferencing platforms were an essential part of teaching during the pandemic. Most educators in this study selected recording technology for lectures as the most useful educational technology tool integrated into the didactic portion of their program. For many educators, having administration realize the adoption of technology is integral to and viable for radiologic science programs was a positive outcome of COVID-19. The pandemic caused educators in the study to experience fatigue and burnout related to online learning; however, the educators also expressed a high degree of comfort with using technology in the online learning environment. This implies that the source of fatigue and burnout was likely not associated with the technology, but with the focused and swift transition to predominately online learning.

CONCLUSION

Although educators in this sample felt moderately prepared to handle future viral outbreaks and extremely comfortable using technology in the virtual classroom, additional research is needed to develop viable contingency plans and explore pedagogical approaches to content delivery beyond the traditional, in-person structure.

COVID-19 Contingency Planning Among Radiologic Science Programs

PURPOSE

To examine radiologic science programs' contingency planning related to the COVID-19 pandemic.

METHODS

Using a mixed-methods approach, educators in magnetic resonance, medical dosimetry, radiation therapy, and radiography programs were surveyed to identify curricular changes, policy implementation, and financial implications related to pandemic recovery efforts. Quantitative data were summarized using descriptive statistics and percentages. Thematic analyses were performed on the qualitative responses.

RESULTS

Continued curricular changes involved using technology to teach in the online environment and ensuring the safety and protection of students during clinical rotations. Institutional policies implemented because of the pandemic included social distancing guidelines, mask requirements, and availability of vaccine. The greatest financial implication witnessed among the sample of educators at their respective institutions was the halting of employer-related travel. Faced with the spontaneous shift to online learning while not being equipped with the appropriate training, most of the educator participants experienced COVID-19 fatigue and burnout related to teaching online.

DISCUSSION

Social distancing guidelines make it difficult for large classes to meet in person, so virtual lectures using video conferencing platforms were an essential part of teaching during the pandemic. Most educators in this study selected recording technology for lectures as the most useful educational technology tool integrated into the didactic portion of their program. For many educators, having administration realize the adoption of technology is integral to and viable for radiologic science programs was a positive outcome of COVID-19. The pandemic caused educators in the study to experience fatigue and burnout related to online learning; however, the educators also expressed a high degree of comfort with using technology in the online learning environment. This implies that the source of fatigue and burnout was likely not associated with the technology, but with the focused and swift transition to predominately online learning.

CONCLUSION

Although educators in this sample felt moderately prepared to handle future viral outbreaks and extremely comfortable using technology in the virtual classroom, additional research is needed to develop viable contingency plans and explore pedagogical approaches to content delivery beyond the traditional, in-person structure.

Re-Starting the Cruise Sector during the COVID-19 Pandemic in Greece: Assessing Effectiveness of Port Contingency Planning

Coronavirus disease (COVID-19) outbreaks on board cruise ships early in the pandemic highlighted gaps worldwide in public health emergency contingency plans (PHECPs) for responding to unknown threats. To restart cruise operations in 2021 and respond to potential COVID-19 outbreaks, a major tourist-based Greek island port (Port A) developed a COVID-19 PHECP. We assessed plan effectiveness by reviewing epidemiological data and monitoring outcomes, followed by an intra-action review (IAR) analyzing three event responses. From May to December 2021, 118 calls from 23 cruise ships with 119,930 passengers were recorded, with 29 COVID-19 cases in 11 cruises on board 7 ships. No outbreak was recorded during the study period. Strengths of the introduced PHECP included commitment of senior management; a core multi-disciplinary team of local authorities/ship agents involved in design and execution; interoperability agreements for port and ships' PHECPs; cruise industry commitment to compliance; and pre-existing scenarios considering capacity needs. Central government coordination for preparedness planning at local ports is essential for successful responses. Monitoring local and country level response capacities is critical to inform planning, risk assessment, and decision-making. Immediately recording ports' response actions provides the basis to capture lessons and improve contingency plans. To facilitate communication and common response protocols between European and non-European ports, IARs should be conducted between countries.

Impact of Omicron on sick leave across industries: A population-wide study

AIMS

To estimate the industry-specific impact of the COVID-19 pandemic (Omicron wave) on sick leave.

METHODS

Using individual-level data from the Norwegian Emergency Preparedness Register, the study covers all workers in different industries (N = 2,733,751 people) on a monthly level in the time periods January-March 2017-2020 (except March 2020) and 2022 (38,199,536 person-months). We estimated the industry-specific increase in monthly average sick leave during the Omicron wave in 2022 compared with the corresponding months in 2017-2020.

RESULTS

We found an average increase in monthly sick leave rates of 2.92 percentage points (95% CI 2.9-2.94) during the three first months of 2022. The increases were strongest within food and accommodation (4.42 percentage points increase, 95% CI 4.33-4.51) and administrative support services (3.94 percentage points increase, 95% CI 3.85-4.03).

CONCLUSIONS

The Omicron wave resulted in a substantial increase in sick leave, which was unevenly distributed across industries. The results of this study highlight the importance of industry-specific contingency planning when facing the rapid spread of infectious diseases.

Quantitative Analysis of Safety Risks and Relationship with Delayed Project Completion Times

Dynamic work environments in construction and civil infrastructure sectors remain susceptible to safety risks. Although previous research has resulted in improvements, there is currently a gap in measuring temporal impacts of safety risks quantitatively. Precise modeling of potential delays caused by safety incidents is vital for efficient management of risks and making informed decisions on project contingency. Toward this aim, the current research adopts a nondeterministic modeling method to simulate and quantify safety incidents and find correlations with project delays. Using a deductive approach, three research questions were formulated, and investigations conducted on Australian data collected from 2016 onwards. Quantitative impacts of safety risks on project completion times were numerically measured. Furthermore, safety risks were ranked based on their significance of temporal impacts on project performance. This paper contributes to the theory of safety management by developing a nondeterministic method to model impacts of safety risks at both industry and project levels. Practical contributions and outcomes can facilitate using machine learning methods to plan proportionate time buffers to address safety risks.

What Are the Human Resources Required to Control a Foot-and-Mouth Disease Outbreak in Austria?

Contingency planning allows veterinary authorities to prepare a rapid response in the event of a disease outbreak. A recently published foot-and-mouth disease (FMD) simulation study indicated concerns whether capacity was sufficient to control a potential FMD epidemic in Austria. The objectives of the study presented here were to estimate the human resources required to implement FMD control measures and to identify areas of the operational activities that could potentially delay successful control of the disease. The stochastic spatial simulation model EuFMDiS (The European Foot-and-Mouth Disease Spread Model) was used to simulate a potential FMD outbreak and its economic impact, including different control scenarios based on variations of culling, vaccination, and pre-emptive depopulation. In this context, the utilization of human resources was assessed based on the associated EuFMDiS output regarding the performance of operational activities. The assessments show that the number of personnel needed in an outbreak with a stamping-out policy would reach the peak at the end of the second week of control with a median of 540 (257–926) individuals, out of which 31% would be veterinarians. Approximately 58% of these human resources would be attributable to surveillance, followed by staff for cleaning and disinfection activities. Our analysis demonstrates that, of the operational activities, surveillance personnel were the largest factor influencing the magnitude of the outbreak. The aim of the assessment presented here is to assist veterinary authorities in the contingency planning of required human resources to respond effectively to an outbreak of animal diseases such as FMD.

Endangered mountain gorillas and COVID-19: One health lessons for prevention and preparedness during a global pandemic

The world's 1063 mountain gorillas (Gorilla beringei beringei) live in two subpopulations at the borders of the Democratic Republic of Congo, Rwanda, and Uganda. The majority of mountain gorillas are human-habituated to facilitate tourism and research, which brings mountain gorillas into close proximity of people daily. Wild great apes are proven to be susceptible to human pathogens, including viruses that have caused fatal respiratory disease in mountain gorillas (e.g., human metapneumovirus¹ ). This is the result of the close genetic relatedness of humans and gorillas as species, and the structural and genetic similarity in molecular receptors that allow viruses to infect cells² . At the time of writing, there is no evidence that severe acute respiratory syndrome coronavirus 2, the coronavirus that causes coronavirus disease 19 (COVID-19), has infected a mountain gorilla. However, due to the significant potential for human-to-gorilla transmission, mountain gorilla range States took immediate steps to minimize the COVID-19 threat. These actions included a combination of preventive practice around gorillas and other great apes (e.g., mandatory face mask use, increased "social" minimum distancing from gorillas) as well as human public health measures (e.g., daily health/fever screenings, COVID-19 screening, and quarantines). Minimization of the COVID-19 threat also required socioeconomic decision-making and political will, as all gorilla tourism was suspended by late March 2020 and guidelines developed for tourism reopening. A consortium that collaborates and coordinates on mountain gorilla management and conservation, working within an intergovernmental institutional framework, took a multifaceted One Health approach to address the COVID-19 threat to mountain gorillas by developing a phased contingency plan for prevention and response. The aim of this paper is to describe how range States and partners achieved this collaborative planning effort, with intent that this real-world experience will inform similar actions at other great ape sites.

Life in 90 words: opportunities for person-centred care amidst COVID-19

OBJECTIVE

Coronavirus disease 2019 and the consequent public health and social distancing measures significantly impacted on service continuity for mental health patients. This article reports on contingency planning initiative in the Australian public sector.

METHODS

Ninety-word care synopses were developed for each patient. These formed the basis for guided conversations between case managers and consultant psychiatrists to ensure safe service provision and retain a person-centred focus amidst the threat of major staffing shortfalls.

RESULTS

This process identified vulnerable patient groups with specific communication needs and those most at risk through service contraction. The challenges and opportunities for promoting safety and self-management through proactive telehealth came up repeatedly. The guided conversations also raised awareness of the shared experience between patients and professionals of coronavirus disease 2019.

CONCLUSION

There is a parallel pandemic of anxiety which creates a unique opportunity to connect at a human level.

Using structured eradication feasibility assessment to prioritize the management of new and emerging invasive alien species in Europe

Prioritizing the management of invasive alien species (IAS) is of global importance and within Europe integral to the EU IAS regulation. To prioritize management effectively, the risks posed by IAS need to be assessed, but so too does the feasibility of their management. While the risk of IAS to the EU has been assessed, the feasibility of management has not. We assessed the feasibility of eradicating 60 new (not yet established) and 35 emerging (established with limited distribution) species that pose a threat to the EU, as identified by horizon scanning. The assessment was carried out by 34 experts in invasion management from across Europe, applying the Non-Native Risk Management scheme to defined invasion scenarios and eradication strategies for each species, assessing the feasibility of eradication using seven key risk management criteria. Management priorities were identified by combining scores for risk (derived from horizon scanning) and feasibility of eradication. The results show eradication feasibility score and risk score were not correlated, indicating that risk management criteria evaluate different information than risk assessment. In all, 17 new species were identified as particularly high priorities for eradication should they establish in the future, whereas 14 emerging species were identified as priorities for eradication now. A number of species considered highest priority for eradication were terrestrial vertebrates, a group that has been the focus of a number of eradication attempts in Europe. However, eradication priorities also included a diverse range of other taxa (plants, invertebrates and fish) suggesting there is scope to broaden the taxonomic range of attempted eradication in Europe. We demonstrate that broad scale structured assessments of management feasibility can help prioritize IAS for management. Such frameworks are needed to support evidence-based decision-making.

COVID-19: Second Wave or Multiple Peaks, Natural Herd Immunity or Vaccine - We Should be Prepared

Between December 31, 2019, and August 30, 2020 (date of this article), the novel coronavirus and its corresponding infection, coronavirus disease (COVID-19), increased to more than 25 million cases, and 843 158 deaths have been registered. Countries around the world have been affected, albeit in different levels and intensities.Despite implementations of preventive public health measures, most countries are seriously preparing for 1 or more waves. The threat of this surge is likely to persist until herd immunity is acquired either by natural infection or through vaccination. However, given the time frame needed for herd immunity to occur and the low probability that a vaccine will be available on a global scale by the coming fall and winter seasons, contingency preparedness plans should be established and put in place for the coming days or months. These plans should help mitigate new peaks of the pandemic while relaxing the social isolation rules, patient, public health, and hospital levels.In this article, we discuss recommendations that practicing physicians and public health agencies should provide to individuals, especially those at risk of infection, to take and implement pre-emptive measures in anticipation of the potential next peak of the pandemic.

Catching our breath: reshaping rehabilitation services for COVID-19

PURPOSE

War and natural disaster have been spurs to the creation of rehabilitation services. The COVID-19 pandemic poses a different question for existing rehabilitation services: how best to respond to a disaster that is anticipated from afar, but whose shape has yet to take full form?

METHODS

Applying the 5-phase crisis management model of Pearson and Mitroff, we report our experience at one of Scotland's largest centres for rehabilitation, in planning to cope with COVID-19.

RESULTS

Contingency rehabilitation planning can be framed in a 5-phase crisis management model that includes (i) signal detection; (ii) prevention/preparedness; (iii) damage limitation; (iv) recovery; and (v) learning. We have reported the impact of COVID-19 on rehabilitation services within a Scottish context and shared some of our learning.

CONCLUSION

COVID-19 has challenged healthcare worldwide and has served as an amplifier for the recognised ill effects of poverty and inequality. As rehabilitation clinicians, we are in a position to continue advocating for people facing disability, and also seeking and responding to signals of COVID-19's late effects in both COVID-19 and non-COVID-19 patients alike. IMPLICATIONS FOR REHABILITATION COVID-19 has resulted in unprecedented challenges in rehabilitation service planning. Contingency rehabilitation planning can be framed in a 5-phase crisis management model of Pearson and Mitroff, including (i) signal detection; (ii) prevention/preparedness; (iii) damage limitation; (iv) recovery; and (v) learning. COVID-19 has served as an amplifier for the recognised ill effects of poverty and inequality; as rehabilitation clinicians, we are in a position to continue advocating for people facing disability, and also seeking and responding to signals of COVID-19's late effects in both COVID-19 and non-COVID-19 patients alike.

Five Challenges When Managing Mass Casualty or Disaster Situations: A Review Study

Background: Managing mass casualty or disaster incidents is challenging to any person or organisation. Therefore, this paper identifies and describes common challenges to managing such situations, using case and lessons learned reports. It focuses on sudden onset, man-made or technologically caused mass casualty or disaster situations. Methods: A management review was conducted based on a structured search in the PubMed and Web of Science databases. Results: The review included 20 case—and lessons learned reports covering natural disasters, man-made events, and accidents across Europe, the United States of Amerika (USA), Asia and the Middle East. Five common challenges were identified: (1) to identify the situation and deal with uncertainty, (2) to balance the mismatch between the contingency plan and the reality, (3) to establish a functional crisis organization, (4) to adapt the medical response to the actual and overall situation and (5) to ensure a resilient response. Conclusions: The challenges when managing mass casualty or disaster events involved were mainly related to the ability to manage uncertainty and surprising situations, using structured processes to respond. The ability to change mind set, organization and procedures, both from an organizational- and individual perspective, was essential. Non-medical factors and internal factors influenced the medical management. In order to respond in an effective, timely and resilient way, all these factors should be taken into consideration.

Modelling Spatial and Temporal Patterns of African Swine Fever in an Isolated Wild Boar Population to Support Decision-Making

African swine fever (ASF) is a highly contagious disease affecting all suids including wild boar. As the disease can damage commercial pig production and its circulation can threaten international trade, understanding the risks produced by free-living wild boar (as a wildlife reservoir) is important to ensure proportionate policies to exclude the disease, as well as an effective contingency response. The recent spread of the virus into Western Europe has produced concerns in many stakeholders including pig producers and national governments. Unlike in mainland Europe, where wild boar are widespread, in Britain, free-living populations have only recently re-established, and whilst these are still relatively small and isolated, they may provide a sufficient reservoir capable of sustaining disease and may thus present a continual source of infection risk to domestic pigs. This study focuses on one component of the risk produced by wild boar, specifically the distribution and persistence of virus in a landscape produced by the natural circulation of disease within wild boar. We used a spatial individual-based model run across a representation of a real landscape to explore the epidemiological consequences of an introduction of ASF into the Forest of Dean, currently hosting the largest population of wild boar in England. We explore various scenarios including variations in the prophylactic management of boar, as well as variations in reactive management (contingency response) following the detection of disease to evaluate their value in reducing this specific risk (presence of ASF virus of wild boar origin in the landscape). The abundance and distribution of wild boar is predicted to increase across our study extent over the next 20 years. Outbreaks of ASF are not predicted to be self-sustaining, with the median time to disease "burn-out" (no new infections) being 14 weeks. Carcass removal, as a tool in a package of reactive management, was of limited value in reducing the duration of outbreaks in this study. We suggest that useful predictions of some of the risks produced by ASF might be possible using only the distribution of the boar, rather than more difficult abundance or density measures.

EPIC, Scottish Government's Centre of Expertise in Animal Disease Outbreaks: A Model for Provision of Risk-Based Evidence to Policy

EPIC, Scottish Government's Centre of Expertise on Animal Disease Outbreaks, offers a successful and innovative model for provision of scientific advice and analysis to policy-makers in Scotland. In this paper, we describe EPIC's remit and operations, and reflect on three case studies which illustrate how the Centre of Expertise Model provides risk-based evidence through rapid access to emergency advice and analyses, estimating disease risks and improving disease detection, assessing different disease control options, and improving future risk resilience. The successes and challenges faced by EPIC and its members offer useful lessons for animal health researchers and authorities, working in contingency planning for animal health security in other countries.

Continuing Patient Care during Electronic Health Record Downtime

INTRODUCTION

Electronic health record (EHR) downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared.

OBJECTIVE

The objective of this study was to assess the operational implications of downtime with a focus on the clinical laboratory, and to derive recommendations for improved downtime contingency planning.

METHODS

A hybrid qualitative-quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several downtime events, including a hospital-wide EHR shutdown.

RESULTS

During downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of downtime, and how to best address them. Based on these insights, recommendations for improved downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides.

CONCLUSION

This study documents the extent to which downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their downtime contingency plans need to find more effective methods to collect data during these times.

Preflight Contingency Planning Approach for Fixed Wing UAVs with Engine Failure in the Presence of Winds

Preflight contingency planning that utilizes wind forecast in path planning can be highly beneficial to unmanned aerial vehicles (UAV) operators in preventing a possible mishap of the UAV. This especially becomes more important if the UAV has an engine failure resulting in the loss of all its thrust. Wind becomes a significant factor in determining reachability of the emergency landing site in a contingency like this. The preflight contingency plans can guide the UAV operators about how to glide the aircraft to the designated emergency landing site to make a safe landing. The need for a preflight or in-flight contingency plan is even more obvious in the case of a communication loss between the UAV operator and UAV since the UAV will then need to make the forced landing autonomously without the operator. In this paper, we introduce a preflight contingency planning approach that automates the forced landing path generation process for UAVs with engine failure. The contingency path generation aims true reachability to the emergency landing site by including the final approach part of the path in forecast wind conditions. In the contingency path generation, no-fly zones that could be in the area are accounted for and the contingency flight paths do not pass through them. If no plans can be found that fulfill reachability in the presence of no-fly zones, only then, as a last resort, the no-fly zone avoidance rule is relaxed. The contingency path generation utilizes hourly forecast wind data from National Oceanic and Atmospheric Administration for the geographical area of interest and time of the flight. Different from past works, we use trochoidal paths instead of Dubins curves and incorporate wind as a parameter in the contingency path design.

Strategies in Electronic Medical Record Downtime Planning: A Scoping Study

PURPOSE

This review will identify dominant themes, common to published articles that discuss downtime planning in a clinical setting. These common themes will represent key considerations for healthcare organizations' comprehensive downtime plans.

METHOD

A scoping study was performed using search results from PubMed, CINAHL and Medline. The 4 articles meeting the inclusion criteria were analyzed for common themes and findings.

RESULTS

Four common themes were found in the included articles: 1) Communications plans, 2) Procedure review and revision, 3) Managing system availability and 4) Preparing staff for handling incidents.

CONCLUSION

Organizations must have comprehensive downtime plans available to ensure continuity of patient care during the periods of limited availability. A comprehensive downtime plan that includes these four strategies can become the framework for a set of organizational procedures that ensures the best possible access to vital patient information before, during, and after a downtime event.

Use of scenario ensembles for deriving seismic risk

High death tolls from recent earthquakes show that seismic risk remains high globally. While there has been much focus on seismic hazard, large uncertainties associated with exposure and vulnerability have led to more limited analyses of the potential impacts of future earthquakes. We argue that as both exposure and vulnerability are reducible factors of risk, assessing their importance and variability allows for prioritization of the most effective disaster risk-reduction (DRR) actions. We address this through earthquake ensemble modeling, using the example of Nepal. We model fatalities from 90 different scenario earthquakes and establish whether impacts are specific to certain scenario earthquakes or occur irrespective of the scenario. Our results show that for most districts in Nepal impacts are not specific to the particular characteristics of a single earthquake, and that total modeled impacts are skewed toward the minimum estimate. These results suggest that planning for the worst-case scenario in Nepal may place an unnecessarily large burden on the limited resources available for DRR. We also show that the most at-risk districts are predominantly in rural western Nepal, with ∼9.5 million Nepalis inhabiting districts with higher seismic risk than Kathmandu. Our proposed approach provides a holistic consideration of seismic risk for informing contingency planning and allows the relative importance of the reducible components of risk (exposure and vulnerability) to be estimated, highlighting factors that can be targeted most effectively. We propose this approach for informing contingency planning, especially in locations where information on the likelihood of future earthquakes is inadequate.

Relevance of Indirect Transmission for Wildlife Disease Surveillance

Epidemiological models of infectious diseases are essential tools in support of risk assessment, surveillance design, and contingency planning in public and animal health. Direct pathogen transmission from host to host is an essential process of each host–pathogen system and respective epidemiological modeling concepts. It is widely accepted that numerous diseases involve indirect transmission (IT) through pathogens shed by infectious hosts to their environment. However, epidemiological models largely do not represent pathogen persistence outside the host explicitly. We hypothesize that this simplification might bias management-related model predictions for disease agents that can persist outside their host for a certain time span. We adapted an individual-based, spatially explicit epidemiological model that can mimic both transmission processes. One version explicitly simulated indirect pathogen transmission through a contaminated environment. The second version simulated direct host-to-host transmission only. We aligned the model variants by the transmission potential per infectious host (i.e., basic reproductive number R₀) and the spatial transmission kernel of the infection to allow unbiased comparison of predictions. The quantitative model results are provided for the example of surveillance plans for early detection of foot-and-mouth disease in wild boar, a social host. We applied systematic sampling strategies on the serological status of randomly selected host individuals in both models. We compared between the model variants the time to detection and the area affected prior to detection, measures that strongly influence mitigation costs. Moreover, the ideal sampling strategy to detect the infection in a given time frame was compared between both models. We found the simplified, direct transmission model to underestimate necessary sample size by up to one order of magnitude but to overestimate the area put under control measures. Thus, the model predictions underestimated surveillance efforts but overestimated mitigation costs. We discuss parameterization of IT models and related knowledge gaps. We conclude that the explicit incorporation of IT mechanisms in epidemiological modeling may reward by adapting surveillance and mitigation efforts.

Getting help quickly: older people and community worker perspectives of contingency planning for falls management

PURPOSE

Older people living in the community need to plan for getting help quickly if they have a fall. In this paper planning for falls is referred to as contingency planning and is not a falls prevention strategy but rather a falls management strategy. This research explored the perspectives of older people and community workers (CWs) about contingency planning for a fall.

METHOD

Using a qualitative descriptive approach, participants were recruited through a community agency that supports older people. In-depth interviews were conducted with seven older people (67-89 years of age) and a focus group was held with seven workers of mixed disciplines from the same agency. Older people who hadn't fallen were included but were assumed to be at risk of falls because they were in receipt of services. Thematic analysis and concept mapping combined the data from the two participant groups.

RESULTS

Four themes including preconceptions about planning ahead for falling, a fall changes perception, giving, and receiving advice about contingency plans and what to do about falling.

CONCLUSION

Both CWs and older people agree contingency planning requires understanding of individual identity and circumstances. CWs have limited knowledge about contingency planning and may be directive, informative, or conservative. Implications for Rehabilitation Falls can result in serious consequences for older people. There is an evidence-practice gap as availability of and access to contingency planning does not necessarily mean older people will use it in a falls emergency. Older people prefer community workers to be directive or informative about contingency planning options but they do want choice and control. Increased community workers knowledge of, and collaborative decision-making about, contingency planning may promote patient-centered services and assist in closing the evidence-practice gap.

Neither snow nor rain: contingency planning by a clinical reference laboratory courier service for weather related emergencies

To optimize transportation processes, we present herein a contingency plan that coordinates interim measures used to ensure continued and timely services when climate based events might cause an interruption of the usual specimen transportation processes. As an example, we outline the implementation and effectiveness of a contingency plan for network laboratory courier automobile transportation during times of mountain pass highway closure. Data available from an approximately 3-year period from October 10, 2010 through August 29, 2013 revealed a total of 690 complete closures in the eastbound or westbound lanes of the Interstate-90 highway in the Snoqualmie Pass area in the state of Washington. Despite the frequency of closures, the Washington State Department of Transportation was effective in limiting the duration of closures. Road closures of less than 1 hour accounted for 58.7% of the total closures. No recorded closures prevented dispatched couriers from completing a prescheduled Snoqualmie Pass route. We identified no delays as being clinically significant, despite that there were 5 instances of delays greater than 4 hours. We implemented a contingency plan of aiding courier logistics during all times of pass closure. The plan includes an easy to interpret Condition Dashboard as a status indicator and a Decision Tree that references and summarizes information. Overall, the contingency plan allows for an objective, robust, proactive decision support system that has enabled operational flexibility and has contributed to continued safe, on-time specimen transportation; clients and courier and reference laboratory staff have appreciated these features and associated outcomes.

Challenges Encountered During the Veterinary Disaster Response: An Example from Chile

Simple Summary

Disaster preparedness for companion animals has economic, social and welfare benefits, yet many countries continue to omit dogs and cats from their national and regional contingency planning. Responses therefore, are often chaotic, inefficient and uncoordinated, or absent altogether. Documented experiences in Chile contribute to the information supporting the inclusion of companion animals into locally relevant disaster plans. These plans serve to prepare communities and authorities, identify resources available, establish a chain of command, develop local priorities, and subsequently reduce the negative impacts on both human and animal communities.

Abstract

Large-scale disasters have immeasurable effects on human and animal communities. Evaluating and reporting on the response successes and difficulties encountered serves to improve existing preparedness documents and provide support to those in the process of developing plans. Although the majority of disasters occur in low and middle income nations, less than 1% of the disaster literature originates from these countries. This report describes a response to a disease outbreak in domestic dogs in Dichato, Chile following the 2010 earthquake/tsunami. With no national plan coordinating the companion animal response, there was a chaotic approach among animal welfare organizations towards rescue, diagnosis, treatment and record-keeping. Similar to the medical response following the 1985 earthquake near Santiago, we experienced problems within our own teams in maintenance of data integrity and protocol compliance. Loss of infrastructure added complications with transportation, communications and acquisition of supplies. Similar challenges likely occur in most disasters, but can be reduced through pro-active planning at national and local levels. There is sufficient information to support the human and animal welfare benefits of including companion animals in national planning, and lessons learned through this and other experiences can assist planners in the development of comprehensive and locally relevant contingency plans.

A winning combination: the 3Cs of business continuity

Contingency planning is a natural part of business life and is used across identified strategic, financial and operational risks. But is it being done well and is it the right approach all of the time? This paper shows how contingency planning forms one layer of a three-line defence termed 'the 3Cs of business continuity': contingency planning; continuity capability; crisis response. Collectively, 'the 3Cs' help organisations deliver a robust response to the risks that can be seen and those that cannot.

The new normal: lessons learned from SARS for corporations operating in emerging markets

The modern industrialized world was completely caught off guard by the recent SARS outbreak. Fortunately, for most organizations, the impact has been short lived, but management has been provided with a reminder of the impact of the external environment in a world of ever increasing globalization. As seen with the SARS outbreak, a lack of preparedness can have devastating effects on business and warrant inclusion in a business definition of a crisis. This paper uses the recent SARS epidemic as a background to highlight the importance of crisis planning, particularly in emerging economies, and suggests how organizations can address these concerns.