Definition and functions of health unified command and emergency operations centers for large-scale bioevent disasters within the existing ICS

The incident command system provides an organizational structure at the agency, discipline, or jurisdiction level for effectively coordinating response and recovery efforts during most conventional disasters. This structure does not have the capacity or capability to manage the complexities of a large-scale health-related disaster, especially a pandemic, in which unprecedented decisions at every level (eg, surveillance, triage protocols, surge capacity, isolation, quarantine, health care staffing, deployment) are necessary to investigate, control, and prevent transmission of disease. Emerging concepts supporting a unified decision-making, coordination, and resource management system through a health-specific emergency operations center are addressed and the potential structure, function, roles, and responsibilities are described, including comparisons across countries with similar incident command systems.     

Evolving need for alternative triage management in public health emergencies: a Hurricane Katrina case study

In many countries, traditional medical planning for disasters developed largely in response to battlefield and multiple casualty incidents, generally involving corporal injuries. The mass evacuation of a metropolitan population in the aftermath of Hurricane Katrina evolved into life-and-death triage scenarios involving thousands of patients with nontraumatic illnesses and special medical needs. Although unprecedented in the United States, triage management needs for this disaster were similar to other large-scale public health emergencies, both natural and human-generated, that occurred globally in the past half-century. The need for alternative triage-management processes similar to the methodologies of other global mass public health emergencies is illustrated through the experience of disaster medical assistance teams in the first 3 days following Katrina's landfall. The immediate establishment of disaster-specific, consensus-based, public health emergency-related triage protocols-developed with ethical and legal expertise and a renewed focus on multidimensional, multifactorial matrix decision-making processes-is strongly recommended.     

Disaster preparedness among families of children with special health care needs

Families with children with special health care needs may present a challenge for disaster responders. This study examined the level of personal disaster preparedness among this at-risk population in relation to the general population, and explores whether special health care needs or perception of disaster risk affects preparedness levels. A convenience sample of 145 families presenting to an urban tertiary care children's hospital was surveyed using a previously validated instrument to gather information on levels of preparedness and factors influencing preparedness. In spite of significant special health care needs and concern about disasters, families remain unprepared for a disaster event. Health care and psychosocial support workers are in a unique position to increase preparedness levels in this at-risk population.     

Disaster triage systems for large-scale catastrophic events

Large-scale catastrophic events typically result in a scarcity of essential medical resources and accordingly necessitate the implementation of triage management policies to minimize preventable morbidity and mortality. Accomplishing this goal requires a reconceptualization of triage as a population-based systemic process that integrates care at all points of interaction between patients and the health care system. This system identifies at minimum 4 orders of contact: first order, the community; second order, prehospital; third order, facility; and fourth order, regional level. Adopting this approach will ensure that disaster response activities will occur in a comprehensive fashion that minimizes the patient care burden at each subsequent order of intervention and reduces the overall need to ration care. The seamless integration of all orders of intervention within this systems-based model of disaster-specific triage, coordinated through health emergency operations centers, can ensure that disaster response measures are undertaken in a manner that is effective, just, and equitable.     

A "community as resource" strategy for disaster response

Natural and technological disasters present significant threats to the public's health. The emergency response capabilities of government and private relief organizations are limited. With a strategy in which residents of urban areas are trained in search and rescue, first aid, fire suppression, care and shelter, emergency communications, and disaster mental health, the community becomes a "resource" rather than a "victim."     

Physical and mental health status of soldiers responding to the 2008 Wenchuan earthquake

Objective: While internationally major disasters occur frequently, for any one country they are unusual events. In this project we aimed to identify public health issues arising from the physical and mental health symptoms suffered by the soldier volunteers deployed in an emergency relief task during the Wenchuan earthquake. Methods: Health problems identified in other emergency volunteer populations guided the development of a questionnaire. A cohort of 1,187 soldier volunteers completed the questionnaire, which measured physical and mental health symptoms during their rescue mission. The results were compared with a population norm of soldiers, although baseline data of the respondents were unavailable. Results: Half the respondents reported suffering from skin and mucous membrane problems, followed by respiratory symptoms (38%), digestive (29%) and nervous (22%) symptoms. Despite a low response rate (53%) to the mental health component, nearly half (49%) of those who did respond reported mental health problems. The incidence of the above symptoms were significantly higher than the general soldier population. Conclusions: Health complaints were common in the soldiers, who had not received any formal training in rescue operations. Implications: Non‐professional rescue workers who are not appropriately prepared for the role may suffer more than their professional counterparts. Attention needs to be paid to the health and safety of non‐professional rescue workers, which has been ignored in most disaster management plans. These findings can be used to enhance the understanding of emergency response programs within and outside China, where this particular disaster occurred.     

Key topics for emergency health education in the Pacific

This discussion of key emergency health topics is meant to provide a primer for the public health practitioner beginning the study of emergency preparedness and response. The discussion focuses on the key concepts of: general principles of disaster management; emergency operations planning; incident management systems; disaster communications' mass casualty management; hazardous material response.     

Mental and social health in disasters: relating qualitative social science research and the Sphere standard

Increasingly, social scientists interested in mental and social health conduct qualitative research to chronicle the experiences of and humanitarian responses to disaster We reviewed the qualitative social science research literature in relation to a significant policy document, the Sphere Handbook, which includes a minimum standard in disaster response addressing "mental and social aspects of health", involving 12 interventions indicators. The reviewed literature in general supports the relevance of the Sphere social health intervention indicators. However, social scientists' chronicles of the diversity and complexity of communities and responses to disaster illustrate that these social interventions cannot be assumed helpful in all settings and times. With respect to Sphere mental health intervention indicators, the research largely ignores the existence and well-being of persons with pre-existing, severe mental disorders in disasters, whose well-being is addressed by the relevant Sphere standard. Instead, many social scientists focus on and question the relevance of posttraumatic stress disorder-focused interventions, which are common after some disasters and which are not specifically covered by the Sphere standard. Overall, social scientists appear to call for a social response that more actively engages the political, social, and economic causes of suffering, and that recognizes the social complexities and flux that accompany disaster. By relating social science research to the Sphere standard for mental and social health, this review informs and illustrates the standard and identifies areas of needed research.     

Ethical issues raised in addressing the needs of people with serious mental disorders in complex emergencies

Recent manmade and natural disasters highlight weaknesses in the public health systems designed to protect populations from harm and minimize disruption of the social and built environments. Emergency planning and response efforts have, as a result, focused largely on ensuring populations' physical well-being during and after a disaster. Many public health authorities, including the World Health Organization, have recognized the importance of addressing both mental and physical health concerns in emergency plans. Individuals with mental disorders represent a notable proportion of the overall population, and anticipating their needs is critical to comprehensive emergency planning and response efforts. Because people with serious mental disorders historically have been stigmatized, and many individuals with mental disorders may be unable to care for themselves, ethical guidance may be of assistance to those engaged in emergency planning and response. This article considers several broad categories of ethical issues that arise during emergencies for people with serious mental disorders and offers recommendations for ways in which emergency planners and other stakeholders can begin to address these ethical challenges.     

Disasters in urban context

This article provides a brief overview of the field of disaster research, summarizing what is known at present about the prevalence of disasters, the range of stressors and outcomes experienced, and sample-, event-, and individual-level risk factors for poor health and mental health outcomes. Prior research does not suggest that an urban context either enhances or reduces risk for individual survivors. It is argued, however, that the influence of extraindividual exposure, ethnic diversity, and support deterioration may be especially salient for understanding urban disasters. Investigators of urban disasters are especially well situated to expand knowledge of ecological and collective aspects of disaster response and recovery.     

Oklahoma city: Disaster challenges mental health and medical administrators

Mental health and medical administrators responded to the Oklahoma City bombing with cooperative and overlapping efforts to meet community needs in the wake of terrorism. The major agencies assisted in the immediate rescue response, organized crisis hotlines, prepared mental health professionals to counsel bereaved families and victims, organized debriefing of rescuers, assessed mental health needs of local school children, planned for longer term treatment, and coordinated research efforts to learn from the disaster. Implications to mental health administrators responding to significant acts of terrorism are discussed.     

The integration of mental and behavioral health into disaster preparedness, response, and recovery

The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health into disaster and emergency preparedness and response activities. One vital opportunity to improve integration is the development of clear and directive national policy to firmly establish the role of mental and behavioral health as part of a unified public health and medical response to disasters. Integration of mental and behavioral health into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services, addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.     

Evidence-Based Practices in Community Mental Health: Outcome Evaluation

In 2003, questions were being raised relating to the lack of evidence-based treatments available in public mental health and whether the use of treatments found effective in research settings would be equally effective in real world situations. In response, one state passed a bill mandating a disease management model of service delivery and the use of evidence-based practices designed to obtain better clinical and functional outcomes, and to maximize the possibility for recovery for adults experiencing a serious mental illness. The purpose of this article is to provide an overview of the re-engineered public mental health system and report on findings of a longitudinal time-series study of the redesigned community mental health system. Findings of the study suggest using evidence-based practices and following a disease management model of mental health service delivery can be effective in real world settings for adults experiencing serious mental health symptoms and functional impairment.     

浅析快速卫生需求评估在救灾防病中的必要性

灾后快速卫生需求评估在整个救灾防病工作中具有重要的意义,是灾后公共卫生应急响应不可残缺的组成部分.及时、迅速地开展灾区快速卫生需求评估,可以在有限的资源下,梳理出轻重缓急,筛选出优先工作顺序,为政府救灾防病提供决策依据,保证救灾资源科学合理的分配、调度,避免反应过度或不足.本文从快速卫生需求评估的概念及特点出发,通过快速卫生需求评估在救灾防病中的应用来阐述快速卫生需求评估的重要性和必要性,同时也对快速卫 生需求评估在灾害医学领域中的应用前景进行了总结和展望.     

Building human resilience: the role of public health preparedness and response as an adaptation to climate change

Global climate change will increase the probability of extreme weather events, including heatwaves, drought, wildfire, cyclones, and heavy precipitation that could cause floods and landslides. Such events create significant public health needs that can exceed local capacity to respond, resulting in excess morbidity or mortality and in the declaration of disasters. Human vulnerability to any disaster is a complex phenomenon with social, economic, health, and cultural dimensions. Vulnerability to natural disasters has two sides: the degree of exposure to dangerous hazards (susceptibility) and the capacity to cope with or recover from disaster consequences (resilience). Vulnerability reduction programs reduce susceptibility and increase resilience. Susceptibility to disasters is reduced largely by prevention and mitigation of emergencies. Emergency preparedness and response and recovery activities--including those that address climate change--increase disaster resilience. Because adaptation must occur at the community level, local public health agencies are uniquely placed to build human resilience to climate-related disasters. This article discusses the role of public health in reducing human vulnerability to climate change within the context of select examples for emergency preparedness and response.     

Mental health interventions for children in adversity: pilot-testing a research strategy for treatment selection in low-income settings

This study aimed to develop a research strategy to make informed decisions for intervention selection, especially for low- and middle-income countries, as a response to the urgent need to scale-up mental health care for children globally. With this study we address the critical lack of translation of research findings into policy and practice. The research strategy was piloted for development of a family-based intervention in violence-affected areas in Burundi. The research comprised four phases; (a) a qualitative phase to assess needs and determine tentative intervention objectives; (b) a global expert panel to identify and prioritize intervention modalities for low-resource settings; (c) systematic literature review and distillation of practice elements from evidence-based treatments; and (d) stakeholder meetings to explore social-cultural feasibility and acceptability of the developed intervention. The study was conducted between January and November 2010. The research strategy resulted in the development of a stepped family-based care intervention, which combines community mobilization, parent-management training and cognitive behavior therapy elements. This pilot-tested research strategy, encompassing global and local knowledge on needs, feasibility and effectiveness, has the potential to be useful for developing mental health and psychosocial interventions in other settings.     

Emergency mental health: lessons learned from flight 3407

Emergency mental health (EMH), a field that is often not well represented when considering emergency preparedness, is nonetheless a vital component to any disaster response. Emergency mental health issues must be considered not only for victims of disasters and their families, friends, and coworkers but also for both on-scene and off-scene responders and members of the community who may have witnessed the disaster. This article describes the EMH preparation for and response to the crash of Continental Airlines flight 3407 in western New York on February 12, 2009, killing all 49 crew and passengers on board and 1 person on the ground. It describes aspects of the response that went as planned and highlights areas for improvement. The lessons learned from this EMH preparation and response can be used to inform future planning for disaster response.     

Preventing mental disorders in children: a public health priority

BACKGROUND: Mental disorders affect 14% of children, cause significant long-term disability and are arguably the leading health problems that Canadian children face after infancy. Treatment services alone cannot meet children's mental health needs. In addition to treatment, prevention programs hold potential to reduce the number of children with disorders in the population. Effective programs exist for preventing conduct, anxiety and depressive disorders, three of the most prevalent disorders in children. Therefore, we investigated the state of Canadian programs in comparison with prevention programs described in the literature for these three disorders. METHODS: We identified children's mental health and early child development (ECD) programs across Canada with national or provincial/territorial scope and significance and with potential relevance to mental health. We then interviewed policy-makers to determine which programs included goals related to mental health, and incorporated key features from programs known to be effective for preventing the three disorders of interest. RESULTS: No prevention programs specific to children's mental health were identified. However, 17 ECD programs incorporated generic goals related to mental health and incorporated key features seen in effective prevention programs. Only Ontario's Better Beginnings, Better Futures (BBBF) explicitly included mental health within its major program goals, incorporated multiple features seen in effective (conduct disorder) prevention programs and demonstrated positive child mental health outcomes. DISCUSSION: The lack of Canadian prevention programs specific to children's mental health is concerning. ECD programs have the potential to improve child mental health outcomes within their wider mandates. BBBF is an exemplar for such programs. However, new investments in implementing (and evaluating) programs that specifically aim to prevent mental disorders are required to improve the mental health of children in the population. Preventing children's mental disorders must be a Canadian public health priority.     

Caring for a surge of Hurricane Katrina evacuees in primary care clinics

Primary care physicians are rarely mentioned in medical disaster plans. We describe how a group of mostly family physicians and administrators of the JPS Health Network (JPS) took primary responsibility for 3,700 evacuees of Hurricane Katrina who came to Tarrant County, Texas. JPS provided medical care to 1,664 (45%) evacuees during a 2-week period. The most common needs were medications for chronic illnesses and treatment of skin infections (primarily on the feet). The JPS Emergency Department saw only 148 evacuees, most of whom arrived by their own transportation and were not seriously ill. JPS created a triage center located several miles from the hospital that referred almost all evacuees with health care needs to a primary care clinic. It was an effective approach for caring for the medical needs of disaster victims and prevented an emergency department and hospital from being overwhelmed. The JPS experience may guide future planning efforts for natural or manmade disasters, especially pandemic threats.     

A focus group investigation into young children's understanding of mental health and their views on appropriate services for their age group

BACKGROUND: Children's views about mental health and concurrent service provision are under researched areas. Yet there is concern regarding appropriate service development to meet the increasing mental health needs of children and young people. Recent government policy underlines the need for collaborative work with consumers in service development. METHOD: This was a qualitative study designed to explore 10- and 11-year-old children's understanding of the concept of mental health and their opinions regarding an appropriate service for their age group. Two focus groups were conducted with 10- and 11-year-old children and the data was analysed using Interpretative Phenomenological Analysis. RESULTS: The participants showed a sophisticated understanding of mental health. The participants thought that school-based services would not be appropriate for their age group. CONCLUSION: The participants demonstrated that their level of understanding and interest qualifies them for a place in discussions about services for their age group. Collaborative work with children and young people in line with government policy in this area is necessary for appropriate service development.