Evaluating Response Planning Initiatives: Modeling Assumptions

Abstract Background The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems. Intervention The Medical Emergency-Pandemic Operations Command (MEOC)—a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada—partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes. Methods In this manuscript, we describe MEOC’s Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan’s structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data. Key Results From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March–May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units. Conclusions MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.

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Applying the Social Vulnerability Index as a Leading Indicator to Protect Fire-Based Emergency Medical Service Responders’ Health

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158049 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8049

Author(s):

Emily J. Haas ◽

Alexa Furek ◽

Megan Casey ◽

Katherine N. Yoon ◽

Susan M. Moore

Keyword(s):

Emergency Response ◽

Social Vulnerability ◽

Vulnerability Index ◽

Fire Service ◽

Household Composition ◽

Fire Departments ◽

Social Vulnerability Index ◽

Response Planning ◽

Leading Indicator ◽

Increased Risk

During emergencies, areas with higher social vulnerability experience an increased risk for negative health outcomes. However, research has not extrapolated this concept to understand how the workers who respond to these areas may be affected. Researchers from the National Institute for Occupational Safety and Health (NIOSH) merged approximately 160,000 emergency response calls received from three fire departments during the COVID-19 pandemic with the CDC’s publicly available Social Vulnerability Index (SVI) to examine the utility of SVI as a leading indicator of occupational health and safety risks. Multiple regressions, binomial logit models, and relative weights analyses were used to answer the research questions. Researchers found that higher social vulnerability on household composition, minority/language, and housing/transportation increase the risk of first responders’ exposure to SARS-CoV-2. Higher socioeconomic, household, and minority vulnerability were significantly associated with response calls that required emergency treatment and transport in comparison to fire-related or other calls that are also managed by fire departments. These results have implications for more strategic emergency response planning during the COVID-19 pandemic, as well as improving Total Worker Health® and future of work initiatives at the worker and workplace levels within the fire service industry.

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Medical Challenges in Underground Warfare

Military Medicine ◽

10.1093/milmed/usaa447 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 839-844

Author(s):

Alex Sorkin ◽

Roy Nadler ◽

Adir Sommer ◽

Avishai M Tsur ◽

Jacob Chen ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Trauma Registry ◽

Smoke Inhalation ◽

Expert Committee ◽

Medical Support ◽

Response Planning ◽

Combat Casualty ◽

Combat Casualty Care

ABSTRACT Introduction Throughout history, underground systems have served military purposes in both offensive and defensive tactical settings. With the advance of underground mining, combat tactics, and weapon systems, providing medical support in the subterranean battlefield is a constantly growing challenge. This retrospective cohort study describes the Israeli Defense Force (IDF) Medical Corps experience with treating casualties from underground warfare, as recorded in the IDF Trauma Registry. Methods A retrospective cohort study of all casualties engaged in underground warfare, between the years 2004-2018. Medical data were extracted from the IDF Trauma Registry and tactical data were obtained from operational reports. An expert committee characterized the most prevalent challenges. Recommendations were based on a literature review and the lessons learned by the IDF experience. Results During the study period, 26 casualties were injured in the underground terrain. Of casualties, 12 (46%) due to blast injuries, 9 (35%) were due to smoke inhalation, and 5 (19%) due to crushing injuries. All were males, and the average age was 21.6 years. Ten (38%) were killed in action (died before reaching a medical facility). All 16 casualties reaching the hospital survived (Table I). The expert committee divided the most common challenges into three categories—tactical, environmental, and medical. An overview of medical response planning, common injuries, and designated combat casualty care are discussed below. As in all combat casualty care, the focus should be on safety, bleeding control, and rapid evacuation. Conclusion To plan and provide medical support, a thorough understanding of operational planning is essential. This manuscript presents the evolution of underground warfare, tactical and medical implications, environmental hazards, and common casualty care challenges.

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18.H. Workshop: Bringing evidence during public health emergencies: addressing the challenge through HTA

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.941 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

◽

Keyword(s):

Public Health ◽

Decision Making ◽

Emergency Preparedness ◽

Public Health Emergency ◽

Decision Makers ◽

Evidence Based ◽

Public Health Emergencies ◽

Response Planning ◽

Emergency Preparedness And Response ◽

Public Health Emergency Preparedness

Abstract Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and irrefutable evidence may be lacking. The process of including evidence in public health decision-making and for evidence-informed policy, in preparation, and during public health emergencies, is not systematic and is complicated by many barriers as the absences of shared tools and approaches for evidence-based preparedness and response planning. Many of today's public health crises are also cross-border, and countries need to collaborate in a systematic and standardized way in order to enhance interoperability and to implement coordinated evidence-based response plans. To strengthen the impact of scientific evidence on decision-making for public health emergency preparedness and response, it is necessary to better define mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies and the context in which these mechanisms operate. As a multidisciplinary, standardized and evidence-based decision-making tool, Health Technology Assessment (HTA) represents and approach that can inform public health emergency preparedness and response planning processes; it can also provide meaningful insights on existing preparedness structures, working as bridge between scientists and decision-makers, easing knowledge transition and translation to ensure that evidence is effectively integrated into decision-making contexts. HTA can address the link between scientific evidence and decision-making in public health emergencies, and overcome the key challenges faced by public health experts when advising decision makers, including strengthening and accelerating knowledge transfer through rapid HTA, improving networking between actors and disciplines. It may allow a 360° perspective, providing a comprehensive view to decision-making in preparation and during public health emergencies. The objective of the workshop is to explore and present how HTA can be used as a shared and systematic evidence-based tool for Public Health Emergency Preparedness and Response, in order to enable stakeholders and decision makers taking actions based on the best available evidence through a process which is systematic and transparent. Key messages There are many barriers and no shared mechanisms to bring evidence in decision-making during public health emergencies. HTA can represent the tool to bring evidence-informed actions in public health emergency preparedness and response.

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