Altered Standards of Care During an Influenza Pandemic: Identifying Ethical, Legal, and Practical Principles to Guide Decision Making

2009 ◽  
Vol 3 (S2) ◽  
pp. S132-S140 ◽  
Author(s):  
Donna Levin ◽  
Rebecca Orfaly Cadigan ◽  
Paul D. Biddinger ◽  
Suzanne Condon ◽  
Howard K. Koh ◽  
...  
Keyword(s):  
Public Health ◽  
Planning Process ◽  
Influenza Pandemic ◽  
State Level ◽  
Mass Casualty ◽  
Standards Of Care ◽  
Public Health Preparedness ◽  
Community Stakeholders ◽  
Mass Casualty Events ◽  
Public Health Officials

ABSTRACTAlthough widespread support favors prospective planning for altered standards of care during mass casualty events, the literature includes few, if any, accounts of groups that have formally addressed the overarching policy considerations at the state level. We describe the planning process undertaken by public health officials in the Commonwealth of Massachusetts, along with community and academic partners, to explore the issues surrounding altered standards of care in the event of pandemic influenza. Throughout 2006, the Massachusetts Department of Public Health and the Harvard School of Public Health Center for Public Health Preparedness jointly convened a working group comprising ethicists, lawyers, clinicians, and local and state public health officials to consider issues such as allocation of antiviral medications, prioritization of critical care, and state seizure of private assets. Community stakeholders were also engaged in the process through facilitated discussion of case scenarios focused on these and other issues. The objective of this initiative was to establish a framework and some fundamental principles that would subsequently guide the process of establishing specific altered standards of care protocols. The group collectively identified 4 goals and 7 principles to guide the equitable allocation of limited resources and establishment of altered standards of care protocols. Reviewing and analyzing this process to date may serve as a resource for other states. (Disaster Med Public Health Preparedness. 2009;3(Suppl 2):S132–S140)

Postexposure Interventions to Prevent Infection With HBV, HCV, or HIV, and Tetanus in People Wounded During Bombings and Other Mass Casualty Events—United States, 2008: Recommendations of the Centers for Disease Control and Prevention and Disaster Medicine and Public Health Preparedness

2008 ◽  
Vol 2 (3) ◽  
pp. 150-165 ◽  
Author(s):  
Louisa E. Chapman ◽  
Ernest E. Sullivent ◽  
Lisa A. Grohskopf ◽  
Elise M. Beltrami ◽  
Joseph F. Perz ◽  
...  
Keyword(s):  
Public Health ◽  
Disease Control ◽  
Emergency Response ◽  
Mass Casualty ◽  
Acute Injury ◽  
Mass Casualties ◽  
Public Health Preparedness ◽  
Mass Casualty Event ◽  
Public Health Officials ◽  
Centers For Disease Control

ABSTRACTPeople wounded during bombings or other events resulting in mass casualties or in conjunction with the resulting emergency response may be exposed to blood, body fluids, or tissue from other injured people and thus be at risk for bloodborne infections such as hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or tetanus. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma, and emergency response medical communities participating in the Centers for Disease Control and Prevention’s Terrorism Injuries: Information, Dissemination and Exchange project. The recommendations contained in this report represent the consensus of US federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community. (Disaster Med Public Health Preparedness. 2008;2:150–165)

Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events: Current Initiatives

2010 ◽  
Vol 4 (2) ◽  
pp. 174-177 ◽  
Author(s):  
Clare Stroud ◽  
Bruce M. Altevogt ◽  
Lewis R. Goldfrank
Keyword(s):  
Public Health ◽  
Influenza Pandemic ◽  
H1n1 Influenza ◽  
Shared Responsibility ◽  
Common Element ◽  
Standards Of Care ◽  
Institute Of Medicine ◽  
Catastrophic Events ◽  
Public Health Preparedness ◽  
Medical Countermeasures

ABSTRACTIt is only possible to achieve a resilient community and an integrated, comprehensive, and resilient health system that can respond effectively to a public health emergency through active collaboration, coordination, and shared responsibility among a broad group of public and private stakeholders and the community itself. The Institute of Medicine established the Forum on Medical and Public Health Preparedness for Catastrophic Events in 2007 to provide a neutral venue for dialogue and collaboration among stakeholders in the preparedness field. In the Forum's first year, the members began to address topics such as medical countermeasures dispensing, crisis standards of care, and medical surge capacity. In the past 9 months, the Forum members have expanded their areas of interest in response to current events and national areas of focus. Current topics include individual, family, and community preparedness and resiliency; medical countermeasures from development through dispensing; and the response to the 2009 H1N1 influenza pandemic. Across all of the initiatives undertaken by the Forum, the common element is that they tackle problems, gaps, and future opportunities that can only be successfully addressed if multiple stakeholders work together.(Disaster Med Public Health Preparedness. 2010;4:174-177)

Mass Casualty Triage: An Evaluation of the Science and Refinement of a National Guideline

2011 ◽  
Vol 5 (2) ◽  
pp. 129-137 ◽  
Author(s):  
E. Brooke Lerner ◽  
David C. Cone ◽  
Eric S. Weinstein ◽  
Richard B. Schwartz ◽  
Phillip L. Coule ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
National Guideline ◽  
Public Health Preparedness ◽  
The Core ◽  
Individual Assessment ◽  
Triage Category

ABSTRACTMass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.(Disaster Med Public Health Preparedness. 2011;5:129-137)

Planning for the next influenza pandemic: Using the science and art of logistics

2019 ◽  
Vol 14 (4) ◽  
pp. 287-298
Author(s):  
O. Shawn Cupp, PhD ◽  
Brad G. Predmore, MHA
Keyword(s):  
Palliative Care ◽  
Planning Process ◽  
Influenza Pandemic ◽  
Healthcare Providers ◽  
Work Force ◽  
Mass Casualty ◽  
Second Step ◽  
Protective Equipment ◽  
Science And Art ◽  
Care Situation

The complexities and challenges for healthcare providers and their efforts to provide fundamental basic items to meet the logistical demands of an influenza pandemic are discussed in this article. The supply chain, planning, and alternatives for inevitable shortages are some of the considerations associated with this emergency mass critical care situation. The planning process and support for such events are discussed in detail with several recommendations obtained from the literature and the experience from recent mass casualty incidents (MCIs). The first step in this planning process is the development of specific triage requirements during an influenza pandemic. The second step is identification of logistical resources required during such a pandemic, which are then analyzed within the proposed logistics science and art model for planning purposes. Resources highlighted within the model include allocation and use of work force, bed space, intensive care unit assets, ventilators, personal protective equipment, and oxygen. The third step is using the model to discuss in detail possible workarounds, suitable substitutes, and resource allocation. An examination is also made of the ethics surrounding palliative care within the construction of an MCI and the factors that will inevitably determine rationing and prioritizing of these critical assets to palliative care patients.

Emergency Preparedness Law and Willingness to Respond in the EMS Workforce

2014 ◽  
Vol 29 (4) ◽  
pp. 358-363 ◽  
Author(s):  
Lainie Rutkow ◽  
Jon S. Vernick ◽  
Carol B. Thompson ◽  
Ronald G. Pirrallo ◽  
Daniel J. Barnett
Keyword(s):  
Public Health ◽  
Emergency Preparedness ◽  
Influenza Pandemic ◽  
State Level ◽  
National Registry ◽  
Public Health Emergency ◽  
Emergency Plan ◽  
Publication Type ◽  
Emergency Medical ◽  
The Government

AbstractIntroductionFor effective responses to emergencies, individuals must have the ability to respond and also be willing to participate in the response. A growing body of research points to gaps in response willingness among several occupational cohorts with response duties, including the Emergency Medical Services (EMS) workforce. Willingness to respond is particularly important during an influenza or other pandemic, due to increased demands on EMS workers and the potential for workforces to be depleted if responders contract influenza or stay home to care for sick dependents. State emergency preparedness laws are one possible avenue to improve willingness to respond.HypothesisPresence of certain state-level emergency preparedness laws (ie, ability to declare a public health emergency; requirement to create a public health emergency plan; priority access to health resources for responders) is associated with willingness to respond among EMS workers.MethodsFour hundred twenty-one EMS workers from the National Registry of Emergency Medical Technicians’ (NREMT's) mid-year Longitudinal EMT Attributes and Demographics Study (LEADS) were studied. The survey, which included questions about willingness to respond during an influenza pandemic, was fielded from May through June 2009. Survey data were merged with data about the presence or absence of the three emergency preparedness laws of interest in each of the 50 US states. Unadjusted logistic regression analyses were performed with the presence/absence of each law and were adjusted for respondents’ demographic/locale characteristics.ResultsCompared to EMS workers in states that did not allow the government to declare a public health emergency, those in states that permitted such declarations were more likely to report that they were willing to respond during an influenza pandemic. In adjusted and unadjusted analyses, this difference was not statistically significant. Similar results were found for the other state-level emergency preparedness laws of interest.ConclusionWhile state-level emergency preparedness laws are not associated with willingness to respond, recent research suggests that inconsistencies between the perceived and objective legal environments for EMS workers could be an alternative explanation for this study's findings. Educational efforts within the EMS workforce and more prominent state-level implementation of emergency preparedness laws should be considered as a means to raise awareness of these laws. These types of actions are important steps toward determining whether state-level emergency preparedness laws have the potential to promote response willingness among EMS workers.RutkowL, VernickJS, ThompsonCB, PirralloRG, BarnettDJ. Emergency preparedness law and willingness to respond in the EMS workforce. Prehosp Disaster Med. 2014;29(4):1-6.

scholarly journals Mask adherence and rate of COVID-19 across the United States

2021 ◽  
Author(s):  
Charlie B. Fischer ◽  
Nedghie Adrien ◽  
Jeremiah J. Silguero ◽  
Julianne J. Hopper ◽  
Abir I. Chowdhury ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
General Public ◽  
State Level ◽  
The United States ◽  
Policy Makers ◽  
Level Data ◽  
High Adherence ◽  
Key Factor ◽  
Public Health Officials

AbstractMask wearing has been advocated by public health officials as a way to reduce the spread of COVID-19. In the United States, policies on mask wearing have varied from state to state over the course of the pandemic. Even as more and more government leaders encourage or even mandate mask wearing, many citizens still resist the notion. Our research examines mask wearing policy and adherence in association with COVID-19 case rates. We used state-level data on mask wearing policy for the general public and on proportion of residents who stated they always wear masks in public. For all 50 states and the District of Columbia (DC), these data were abstracted by month for April ⍰ September 2020 to measure their impact on COVID-19 rates in the subsequent month (May ⍰ October 2020). Monthly COVID-19 case rates (number of cases per capita over two weeks) >200 per 100,000 residents were considered high. Fourteen of the 15 states with no mask wearing policy for the general public through September reported a high COVID-19 rate. Of the 8 states with at least 75% mask adherence, none reported a high COVID-19 rate. States with the lowest levels of mask adherence were most likely to have high COVID-19 rates in the subsequent month, independent of mask policy or demographic factors. Mean COVID-19 rates for states with at least 75% mask adherence in the preceding month was 109.26 per 100,000 compared to 249.99 per 100,000 for those with less adherence. Our analysis suggests high adherence to mask wearing could be a key factor in reducing the spread of COVID-19. This association between high mask adherence and reduced COVID-19 rates should influence policy makers and public health officials to focus on ways to improve mask adherence across the population in order to mitigate the spread of COVID-19.

‘Gun shop projects’ for suicide prevention in the USA: current state and future directions

2020 ◽  
pp. injuryprev-2020-043648 ◽  
Author(s):  
Evan Polzer ◽  
Sara Brandspigel ◽  
Timothy Kelly ◽  
Marian Betz
Keyword(s):  
Public Health ◽  
Suicide Prevention ◽  
Qualitative Interviews ◽  
National Level ◽  
State Level ◽  
Programme Implementation ◽  
Current State ◽  
The Usa ◽  
Public Health Officials ◽  
The Impact

ObjectivesTo describe community-driven suicide prevention partnerships between firearm retailers and public health officials (‘gun shop projects’), including common elements and challenges.MethodsWe conducted qualitative interviews with leaders from state-level and national-level partnerships to determine common features, challenges and strategies used by these groups. Data were coded via theme analysis; two independent coders followed a shared codebook developed in an iterative fashion and with high inter-rater reliability.ResultsAcross 10 interviews, data revealed four main themes: (1) community building was a cornerstone of these efforts; (2) appropriate messaging and language were vital to successes; (3) groups employed various educational and outreach campaigns and (4) groups identified common challenges and obstacles.ConclusionsGun shop project partnerships between firearm retailers and public health officials show promise, with thematic data demonstrating common trends and steps towards successful programme implementation. Evaluative data are needed to determine the impact of these efforts on suicide prevention in local communities.

Rural Mass Casualty Preparedness and Response: The Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events

2012 ◽  
Vol 6 (3) ◽  
pp. 297-302 ◽  
Author(s):  
Kristin P. Viswanathan ◽  
Robert Bass ◽  
Gamunu Wijetunge ◽  
Bruce M. Altevogt
Keyword(s):  
Public Health ◽  
Best Practices ◽  
Research And Development ◽  
Mass Casualty Incident ◽  
Emerging Technology ◽  
Mass Casualty ◽  
Catastrophic Events ◽  
Public Health Preparedness ◽  
Rural Infrastructure ◽  
Daily Capacity

ABSTRACTThe Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a workshop at the request of the Federal Interagency Committee on Emergency Medical Services (FICEMS) that brought together a range of stakeholders to broadly identify and confront gaps in rural infrastructure that challenge mass casualty incident (MCI) response and potential mechanisms to fill them. This report summarizes the presentations and discussions around 6 major issues specific to rural MCI preparedness and response: (1) improving rural response to MCI through improving daily capacity and capability, (2) leveraging current and emerging technology to overcome infrastructure deficits, (3) sustaining and strengthening relationships, (4) developing and sharing best practices across jurisdictions and sectors, (5) establishing metrics research and development, and (6) fostering the need for federal leadership to expand and integrate EMS into a broader rural response framework.(Disaster Med Public Health Preparedness. 2012;6:297–302)

scholarly journals Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline

2008 ◽  
Vol 2 (S1) ◽  
pp. S25-S34 ◽  
Author(s):  
E. Brooke Lerner ◽  
Richard B. Schwartz ◽  
Phillip L. Coule ◽  
Eric S. Weinstein ◽  
David C. Cone ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Scientific Evidence ◽  
The United States ◽  
Mass Casualty ◽  
National Guideline ◽  
Public Health Preparedness ◽  
Life Saving ◽  
Review Reports ◽  
Triage Decisions

ABSTRACTMass casualty triage is a critical skill. Although many systems exist to guide providers in making triage decisions, there is little scientific evidence available to demonstrate that any of the available systems have been validated. Furthermore, in the United States there is little consistency from one jurisdiction to the next in the application of mass casualty triage methodology. There are no nationally agreed upon categories or color designations. This review reports on a consensus committee process used to evaluate and compare commonly used triage systems, and to develop a proposed national mass casualty triage guideline. The proposed guideline, entitled SALT (sort, assess, life-saving interventions, treatment and/or transport) triage, was developed based on the best available science and consensus opinion. It incorporates aspects from all of the existing triage systems to create a single overarching guide for unifying the mass casualty triage process across the United States. (Disaster Med Public Health Preparedness. 2008;2(Suppl 1):S25–S34)

scholarly journals Modelling seasonality and viral mutation to predict the course of an influenza pandemic

2010 ◽  
Vol 138 (10) ◽  
pp. 1472-1481 ◽  
Author(s):  
P. SHI ◽  
P. KESKINOCAK ◽  
J. L. SWANN ◽  
B. Y. LEE
Keyword(s):  
Public Health ◽  
Influenza Pandemic ◽  
H1n1 Influenza ◽  
Seasonal Effects ◽  
Public Health Decision ◽  
Viral Mutation ◽  
Daily Rate ◽  
Health Decision ◽  
Public Health Officials ◽  
2009 H1n1

SUMMARYAs the 2009 H1N1 influenza pandemic (H1N1) has shown, public health decision-makers may have to predict the subsequent course and severity of a pandemic. We developed an agent-based simulation model and used data from the state of Georgia to explore the influence of viral mutation and seasonal effects on the course of an influenza pandemic. We showed that when a pandemic begins in April certain conditions can lead to a second wave in autumn (e.g. the degree of seasonality exceeding 0·30, or the daily rate of immunity loss exceeding 1% per day). Moreover, certain combinations of seasonality and mutation variables reproduced three-wave epidemic curves. Our results may offer insights to public health officials on how to predict the subsequent course of an epidemic or pandemic based on early and emerging viral and epidemic characteristics and what data may be important to gather.

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