Mapping US Pediatric Hospitals and Subspecialty Critical Care for Public Health Preparedness and Disaster Response, 2008

2012 ◽  
Vol 6 (2) ◽  
pp. 117-125 ◽  
Author(s):  
Mary D. Brantley ◽  
Hua Lu ◽  
Wanda D. Barfield ◽  
James B. Holt ◽  
Alcia Williams
Keyword(s):  
Public Health ◽  
Critical Care ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Trauma Centers ◽  
Public Health Preparedness ◽  
Preparedness Planning ◽  
Proximity Analysis ◽  
Pediatric Hospitals ◽  
Level I

ABSTRACTObjective: The objective is to describe by geographic proximity the extent to which the US pediatric population (aged 0-17 years) has access to pediatric and other specialized critical care facilities, and to highlight regional differences in population and critical resource distribution for preparedness planning and utilization during a mass public health disaster.Methods: The analysis focused on pediatric hospitals and pediatric and general medical/surgical hospitals with specialized pediatric critical care capabilities, including pediatric intensive care units (PICU), pediatric cardiac ICUs (PCICU), level I and II trauma and pediatric trauma centers, and general and pediatric burn centers. The proximity analysis uses a geographic information system overlay function: spatial buffers or zones of a defined radius are superimposed on a dasymetric map of the pediatric population. By comparing the population living within the zones to the total population, the proportion of children with access to each type of specialized unit can be estimated. The project was conducted in three steps: preparation of the geospatial layer of the pediatric population using dasymetric mapping methods; preparation of the geospatial layer for each resource zone including the identification, verification, and location of hospital facilities with the target resources; and proximity analysis of the pediatric population within these zones.Results: Nationally, 63.7% of the pediatric population lives within 50 miles of a pediatric hospital; 81.5% lives within 50 miles of a hospital with a PICU; 76.1% lives within 50 miles of a hospital with a PCICU; 80.2% lives within 50 miles of a level I or II trauma center; and 70.8% lives within 50 miles of a burn center. However, state-specific proportions vary from less than 10% to virtually 100%. Restricting the burn and trauma centers to pediatric units only decreases the national proportion to 26.3% for pediatric burn centers and 53.1% for pediatric trauma centers.Conclusions: This geospatial analysis describes the current state of pediatric critical care hospital resources and provides a visual and analytic overview of existing gaps in local pediatric hospital coverage. It also highlights the use of dasymetric mapping as a tool for public health preparedness planning.(Disaster Med Public Health Preparedness. 2012;6:117–125)

A National Assessment of the Status of Planning for Public Health Preparedness for Chemical and Radiological Contaminating Terrorism: CSTE's Findings and Recommendations/Executive Summary

2005 ◽  
Vol 14 (4) ◽  
pp. 357-363
Author(s):  
Mary Lee Dunn ◽  
Keyword(s):  
Public Health ◽  
Emergency Response ◽  
The State ◽  
National Assessment ◽  
Public Health Preparedness ◽  
Executive Summary ◽  
Preparedness Planning ◽  
The Status ◽  
Regional Public Health

An association of epidemiologists looks at the state of regional public health preparedness in a time of terrorism in a report that gauges regional readiness. The report examined the status of preparations to deal with chemical and radiological events, and looked at planning gaps, resources, and interagency agreements to coordinate emergency response. The research found inadequate levels of preparedness, planning, and established interagency partnerships and puts forth recommendations to improve the nation's ability to respond.

Temporal Variations in Pediatric Trauma: Rationale for Altered Resource Utilization

2018 ◽  
Vol 84 (6) ◽  
pp. 813-819 ◽  
Author(s):  
Eric M. Groh ◽  
Paul L. Feingold ◽  
Barry Hashimoto ◽  
Lucas A. McDuffie ◽  
Troy A. Markel
Keyword(s):  
Resource Utilization ◽  
Pediatric Population ◽  
Statistical Significance ◽  
Temporal Trends ◽  
Pediatric Trauma ◽  
Temporal Variations ◽  
The Hours ◽  
Hospital Resources ◽  
Level I ◽  
Type Of Injury

Trauma is a major cause of morbidity and mortality in the pediatric population. However, temporal variations of trauma have not been well characterized and may have implications for appropriate allocation of hospital resources. Data from patients evaluated at an ACS-verified Level I pediatric trauma center between 2011 and 2015 were retrospectively analyzed. Date and time of injury, type of injury (blunt vs penetrating), and postemergency department disposition were reviewed. To assess temporal trends, heatmaps were constructed and a mixed poisson regression model was used to assess statistical significance. Pediatric trauma from blunt and penetrating injuries occurred at significantly higher rates between the hours of 1800 and 0100, on weekends compared with weekdays, and from May to August compared with November to February. These data provide useful information for hospital resource utilization. The emergency department, operating room, and intensive care unit should be prepared for increased trauma-related volume between May and August, weekends, and evening hours by appropriately increasing staff volume and resource availability.

Integrating authorities and disciplines into the preparedness-planning process: A study of mental health, public health, and emergency management

2007 ◽  
Vol 2 (3) ◽  
pp. 133-142 ◽  
Author(s):  
Madeline Robertson, JD, MD ◽  
Betty Pfefferbaum, MD, JD ◽  
Catherine R. Codispoti, MHA ◽  
Juliann M. Montgomery, MPH
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Emergency Management ◽  
Disaster Preparedness ◽  
Planning Process ◽  
Barriers To Entry ◽  
Public Health Preparedness ◽  
Preparedness Plan ◽  
Preparedness Planning ◽  
Management Plans

The process of integrating all necessary authorities and disciplines into an organized preparedness plan is complex, and the inclusion of disaster mental health poses specific challenges. The goals of this project were 1) to identify whether state mental health preparedness was included in state public health and emergency management preparedness plans, 2) to document barriers to entry and strategies reportedly used by state authorities in efforts to incorporate reasonable mental health preparedness into existing public health and emergency management preparedness planning, 3) to employ a theory for organizational change to organize and synthesize this information, and 4) to stimulate further discussion and research supporting coordinated preparedness efforts at the state level, particularly those inclusive of mental health. To accomplish these goals we 1) counted the number of state public health preparedness and emergency management plans that either included, mentioned, or omitted a mental health preparedness plan; 2) interviewed key officials from nine representative states for their reports on strategies used in seeking greater inclusion of mental health preparedness in public health and emergency management preparedness planning; and 3) synthesized these results to contribute to the national dialogue on coordinating disaster preparedness, particularly with respect to mental health preparedness. We found that 15 out of 29 publicly available public health preparedness plans (52 percent) included mental health preparedness, and eight of 43 publicly available emergency management plans (18 percent) incorporated mental health. Interviewees reported numerous barriers and strategies, which we cataloged according to a well-accepted eight-step plan for transforming organizations.

scholarly journals Institutional Facilitators and Barriers to Local Public Health Preparedness Planning for Vulnerable and At-Risk Populations

2014 ◽  
Vol 129 (6_suppl4) ◽  
pp. 35-41 ◽  
Author(s):  
Christine A. Bevc ◽  
Matthew C. Simon ◽  
Tanya A. Montoya ◽  
Jennifer A. Horney
Keyword(s):  
Public Health ◽  
At Risk ◽  
Census Data ◽  
Local Level ◽  
Evaluation Study ◽  
Local Health ◽  
Public Health Preparedness ◽  
Preparedness Planning ◽  
At Risk Populations ◽  
Facilitators And Barriers

Objective. Numerous institutional facilitators and barriers to preparedness planning exist at the local level for vulnerable and at-risk populations. Findings of this evaluation study contribute to ongoing practice-based efforts to improve response services and address public health preparedness planning and training as they relate to vulnerable and at-risk populations. Methods. From January 2012 through June 2013, we conducted a multilevel, mixed-methods evaluation study of the North Carolina Preparedness and Emergency Response Research Center's Vulnerable & At-Risk Populations Resource Guide, an online tool to aid local health departments' (LHDs') preparedness planning efforts. We examined planning practices across multiple local, regional, and state jurisdictions utilizing user data, follow-up surveys, and secondary data. To identify potential incongruities in planning, we compared respondents' reported populations of interest with corresponding census data to determine whether or not there were differences in planning priorities. Results. We used data collected from evaluation surveys to identify key institutional facilitators and barriers associated with planning for at-risk populations, including challenges to conducting assessments and lack of resources. Results identified both barriers within institutional culture and disconnects between planning priorities and evidence-based identification of vulnerable and at-risk populations, including variation in the planning process, partnerships, and perceptions. Conclusions. Our results highlight the important role of LHDs in preparedness planning and the potential implications associated with organizational and bureaucratic impediments to planning implementation. A more in-depth understanding of the relationships among public institutions and the levels of preparedness that contribute to the conditions and processes that generate vulnerability is needed.

Comparison of Outcomes for Pediatric Trauma at Different Types of Trauma Centers: The Unresolved Mystery

2018 ◽  
Vol 84 (6) ◽  
pp. 1054-1057
Author(s):  
Adel Elkbuli ◽  
Jennifer R. Lopez ◽  
Paul Perales Villarroel ◽  
Darwin Ang ◽  
Huazhi Liu ◽  
...  
Keyword(s):  
Pediatric Trauma ◽  
Health Care Administration ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Pediatric Hospital ◽  
Pediatric Hospitals ◽  
Crude Mortality Rate ◽  
Level 1 ◽  
Expected Mortality ◽  
Level 2

In Florida, injured children can receive emergent care at one of three types of state-approved trauma centers (TCs). A Level 1 combined adult/pediatric TC (L1, A + P), a Level 2 TC with an associated pediatric hospital (L2 + PH) or a pediatric TC at a pediatric hospital (PTH). This study aims to compare the mortality outcomes between Florida L1, A + Ps, to L2 + PHs, and PTHs. A retrospective review of dataset from the Agency for Health Care Administration compared outcomes from 2013 to 2016 at all three types of TCs. Outcomes were stratified by using the observed over expected mortality (O/E). Significance defined as P < 0.05. A total of 13,428 pediatric trauma patients were treated at all three TCs (L1, A + P, L 2 + PHs, or PTH). L1, A + Ps treated 6975 pediatric patients with 104 deaths [crude mortality rate (CMR) 1.49%, O/E = 0.96], L2 + PHs treated 4066 patients with 69 deaths (CMR 1.70%, O/E = 1.21), PTHs treated 2387 patients with 34 deaths (CMR 1.42%, O/E = 1.25). When O/E's at L1, A + Ps and L2 + PHs were compared, results were statistically significant (P = <0.03),but not at L1, A + P versus PTHs. This is the first study to reveal that Level 1 adult/pediatric TCs have lower mortality rates compared with Level 2 TCs with an associated pediatric hospital. Level 1,A + P TCs had similar outcomes to pediatric TCs at standalone pediatric hospitals.

Pediatric Trauma System Evaluation before and after Level II Verification

2019 ◽  
Vol 85 (11) ◽  
pp. 1281-1287
Author(s):  
Michael D. Dixon ◽  
Scott Engum
Keyword(s):  
Native American ◽  
Trauma Center ◽  
Injury Severity ◽  
Life Support ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Trauma Centers ◽  
Level Ii ◽  
Level I ◽  
Pediatric Trauma Center

ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study ( P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group ( P = 0.0002); motorized recreational vehicle ( P = 0.028), violent ( P = 0.009), and other ( P = 0.0374) mechanism of injury categories; ambulance ( P = 0.0124), fixed wing ( P = 0.0028), and personal-owned vehicle ( P = 0.0112) modes of transportation. Decreased public injuries ( P = 0.0071) and advanced life support ambulance transportation ( P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.

Pediatric trauma mortality: an ecological analysis evaluating correlation between injury-related mortality and geographic access to trauma care in the United States in 2010

2019 ◽  
Author(s):  
Tm Pender ◽  
Ap David ◽  
Bk Dodson ◽  
J Forrest Calland
Keyword(s):  
United States ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
The United States ◽  
Trauma Centers ◽  
Linear Regression Models ◽  
Geographic Access ◽  
Improved Outcomes ◽  
Trauma Mortality ◽  
Related Mortality

ABSTRACT Background Trauma is the leading cause of mortality in the pediatric population &gt;1 year. Analyzing relationships between pediatric trauma-related mortality and geographic access to trauma centers (among other social covariates) elucidates the importance of cost and care effective regionalization of designated trauma facilities. Methods Pediatric crude injury mortality in 49 United States served as a dependent variable and state population within 45 minutes of trauma centers acted as the independent variable in four linear regression models. Multivariate analyses were performed using previously identified demographics as covariates. Results There is a favorable inverse relation between pediatric access to trauma centers and pediatric trauma-related mortality. Though research shows care is best at pediatric trauma centers, access to Adult Level 1 or 2 trauma centers held the most predictive power over mortality. A 4-year college degree attainment proved to be the most influential covariate, with predictive powers greater than the proximity variable. Conclusions Increased access to adult or pediatric trauma facilities yields improved outcomes in pediatric trauma mortality. Implementation of qualified, designated trauma centers, with respect to regionalization, has the potential to further lower pediatric mortality. Additionally, the percentage of state populations holding 4-year degrees is a stronger predictor of mortality than proximity and warrants further investigation.

Addressing Gaps in Health Care Sector Legal Preparedness for Public Health Emergencies

2008 ◽  
Vol 2 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Montrece McNeill Ransom ◽  
Richard A. Goodman ◽  
Anthony D. Moulton
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Legal Issues ◽  
Legal Counsel ◽  
Care Providers ◽  
Public Health Preparedness ◽  
Public Health Emergencies ◽  
Preparedness Planning ◽  
Starting Point

ABSTRACTHealth care providers and their legal counsel play pivotal roles in preparing for and responding to public health emergencies. Lawyers representing hospitals, health systems, and other health care provider components are being called upon to answer complex legal questions regarding public health preparedness issues that most providers have not previously faced. Many of these issues are legal issues with which public health officials should be familiar, and that can serve as a starting point for cross-sector legal preparedness planning involving both the public health and health care communities. This article examines legal issues that health care providers face in preparing for public health emergencies, and steps that providers, their legal counsel, and others can take to address those issues and to strengthen community preparedness. (Disaster Med Public Health Preparedness. 2008;2:50–56)

scholarly journals Iran's Disaster Risk: Now is the Time for Community-based Public Health Preparedness

2013 ◽  
Vol 28 (5) ◽  
pp. 421-422 ◽  
Author(s):  
Ali Ardalan ◽  
Hani Mowafi ◽  
Frederick M. Burkle
Keyword(s):  
Public Health ◽  
Disaster Risk ◽  
Nuclear Facilities ◽  
Publication Type ◽  
Community Based ◽  
Public Health Preparedness ◽  
Policy Makers ◽  
Public Health Emergencies ◽  
Preparedness Planning ◽  
Regional Industrialization

AbstractThe Bandar Bushehr, Iran earthquake of April 9, 2013 gravely illustrates how disaster-prone areas of the world are compounding their risk of disaster and major public health emergencies when there is a geographical convergence of natural and technological hazards. Scientists must emphasize to policy makers that ever-increasing regional industrialization and the broader introduction of nuclear facilities, especially in the Middle East, must parallel sound prevention and community-level public health preparedness planning.ArdalanA, MowafiH, BurkleFM, Jr. Iran's disaster risk: now is the time for community-based public health preparedness. Prehosp Disaster Med. 2013;28(5):1-2.

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