Perceived Effects of the Affordable Care Act on Emergency Preparedness

National healthcare as executed through the Patient Protection and Affordable Care Act (ACA) was introduced in 2010, but was discussed for several decades prior to its enactment. Section 5210 of the ACA established funding for a Regular and Ready Reserve Corps (RRRC) to provide support to local healthcare entities with emergency preparedness. It is unknown what impact Section 5210 of the ACA has had on local emergency preparedness, as well as what obstacles are encountered with implementing this piece of legislation at the local level. The purpose of this case study was to understand the obstacles encountered at a local level by healthcare entities by combining rational choice theory and complex adaptive systems through Ostrom\u27s institutional analysis and development theory. Data for this case study were obtained through interviews with 6 hospital emergency coordinators of hospitals in the Tennessee Highland Rim Region. These data were coded and analyzed following Moustakas\u27 modified Van Kaam procedure. Findings from this study concluded that participants perceived that Section 5210 of the ACA did not impact hospital operations at the local level. However, other obstacles including employee turnover, communication, and process standardization and education are perceived to exist in terms of planning and emergency preparedness. The results of this study may impact social change by enhancing state and local policy makers\u27 ability to identify and create a future roadmap for health care policy implementation at local and regional levels

Advancing the scientific study of prehospital mass casualty response through a Translational Science process: the T1 scoping literature review stage

PurposeThe European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects' objectives, the NIGHTINGALE consortium used a Translational Science (TS) process. The present work is the first TS stage (T1) aimed to extract data relevant for the subsequent modified Delphi study (T2) statements.MethodsThe authors were divided into three work groups (WGs) MCI Triage, PH Life Support and Damage Control (PHLSDC), and PH Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping reviews. Relevant data were extracted from the included articles and indexed using pre-identified PH MCI response themes and subthemes.ResultsThe initial search yielded 925 total references to be considered for title and abstract review (MCI Triage 311, PHLSDC 329, PHP 285), then 483 articles for full reference review (MCI Triage 111, PHLSDC 216, PHP 156), and finally 152 articles for the database extraction process (MCI Triage 27, PHLSDC 37, PHP 88). Most frequent subthemes and novel concepts have been identified as a basis for the elaboration of draft statements for the T2 modified Delphi study.ConclusionThe three simultaneous scoping reviews allowed the extraction of relevant PH MCI subthemes and novel concepts that will enable the NIGHTINGALE consortium to create scientifically anchored statements in the T2 modified Delphi study

Design and decision making to improve healthcare infrastructure

This report presents summary and key findings of research projects undertaken within the Health and Care Infrastructure Research and Innovation Centre (HaCIRIC)by Loughborough University. These projects develop new knowledge and theory on how the built environment adds value to the healthcare delivery process and mainly relate to: ‘Theme 3, Innovative Design and onstruction’ undertaken during HaCIRIC Phase 1; and provide an excellent foundation for the work to be undertaken within the Optimising Healthcare Infrastructure Value (OHIV)project during HaCIRIC Phase 2

ОПТИМАЛЬНАЯ МАРШРУТИЗАЦИЯ ВОЗДУШНЫХ СУДОВ И МАШИН СКОРОЙ ПОМОЩИ В ЛОГИСТИКЕ ПРИ СТИХИЙНЫХ БЕДСТВИЯХ

One of the most vital aspects of emergency management studies is the development and examination of post-disaster search and rescue activities and treatment facilities. One of such issues to be considered while performing these operations is to reach the disaster victims within minimum time and to plan disaster logistics in the most efficient manner possible. In this study, the problem of planning debris scanning activities with Unmanned Aerial Vehicles after an earthquake and transporting the injured people to the hospitals by ambulances within minimum time was discussed, and mathematical models were developed to solve the problem. The ambulance routing problem and the mathematical model to be used in the solution to the problem are discussed for the first time in the literature. The developed model was tested on the problem sets created by taking into account the data of the province under investigation.Одним из наиболее важных аспектов исследований по управлению рисками и чрезвычайными ситуациями является разработка и изучение поисково-спасательных мероприятий и очистных сооружений после стихийных бедствий. Одним из вопросов, которые необходимо учитывать при выполнении этих операций, является обеспечение доступа к жертвам стихийных бедствий в минимальные сроки и планирование логистики в случае стихийных бедствий наиболее эффективным способом. В данном исследовании рассматривается проблема планирования работ по спасению с помощью беспилотных летательных аппаратов после землетрясения и транспортировки пострадавших людей в больницы на машинах скорой помощи за минимальное время. Для решения этой проблемы были разработаны и предложены математические модели. Впервые рассматривается задача маршрутизации скорой помощи и математическая модель, которая будет использоваться для решения этой задачи. Разработанная модель была протестирована на множествах задач, созданных с учетом реальных данных исследуемой провинции Турции

Hospital Network Infrastructure: a Modern Look Into the Network Backbone with Real Time Visibility

For the purposes of this research, the design science discipline of Information Systems will structure the overall methodology and framework for results. By leveraging the design science framework, this study will dissect and analyze various parts of a hospital\u27s network, to uncover substandard practices and problematic weaknesses that commonly result in an overall decrease in the quality of healthcare provided to patients, and negatively affect business operations of hospitals and healthcare facilities. For the purposes of this research the chosen hospital will be categorized as Mid-Western Hospital. This thesis will investigate, in a real world healthcare organization, fault management technologies in the network design using Dual-MAN architecture. By analyzing current network bandwidth performance and financial data of a health care organization, as it relates to network connection cost, organizations can improve network performance and save money in the process. Additionally, this thesis will propose possible solutions to help manage large health care organizations\u27 network

Climate change and health: a tool to estimate health and adaptation costs

Details the correct use of a WHO designed economic analysis tool to support health adaptation planning in European member states.Summary:The WHO Regional Office for Europe prepared this economic analysis tool to support health adaptation planning in European Member States. It is based on a review of the science. It is expected to be applied in Member States mainly by line ministries responsible for climate change adaptation. It provides step-by-step guidance on estimating (a) the costs associated with damage to health due to climate change, (b) the costs for adaptation in various sectors to protect health from climate change and (c) the efficiency of adaptation measures, i.e. the cost of adaptation versus the expected returns, or averted health costs. The tool consists of a document describing the methods step-by-step and a manual with an Excel spreadsheet, which is a visual aid for calculating costs

Ontology-driven multicriteria decision support for victim evacuation

Abstract In light of the complexity of unfolding disasters, the diversity of rapidly evolving events, the enormous amount of generated information, and the huge pool of casualties, emergency responders (ERs) may be overwhelmed and in consequence poor decisions may be made. In fact, the possibility of transporting the wounded victims to one of several hospitals and the dynamic changes in healthcare resource availability make the decision process more complex. To tackle this problem, we propose a multicriteria decision support service, based on the Analytic Hierarchy Process (AHP) method, that aims to avoid overcrowding and outpacing the capacity of a hospital to effectively provide the best care to victims by finding out the most appropriate hospital that meets the victims’ needs. The proposed approach searches for the most appropriate healthcare institution that can effectively deal with the victims’ needs by considering the availability of the needed resources in the hospital, the victim’s wait time to receive the healthcare, and the transfer time that represents the hospital proximity to the disaster site. The evaluation and validation results showed that the assignment of hospitals was done successfully considering the needs of each victim and without overwhelming any single hospital

Antibody Architecture: Responding to Bioterrorism

Bioterrorism, the use of biological and chemical agents for terrorist purposes, is one of the most potentially significant health and security threats currently facing the United States. Healthcare facilities as isolated entities are alone unable to provide sufficient, adaptable emergency response options during a bioterrorist attack--an unpredictable, low probability, high consequence event. Bioterrorism response must be systemic, distributed, flexible, and responsive for a wide range of event incidents, scenarios and contexts. A significant problem yet to be adequately addressed is the mitigation of the walking well--those who are not sick or injured but have the potential to inundate any designated response setting. Architectural interventions alone are limited in their ability to provide an appropriate response to an act of bioterrorism. An analogy to the human immune system and how it operates in the body to overcome pathogens will be used to articulate a systematic bioterrorism response and a series of architectural interventions for dealing with the walking well. Similar to our immune system, a response network (or system) should be created that operates throughout high risk urban contexts and takes advantage of existing architectural settings in order to deploy as needed and where needed in response to a bioterrorist attack. An antibody response to bioterrorism must be able to adapt to meeting the needs of various scenarios and contexts in which an incident might occur. Drawing on this biological metaphor, any proposed architectural interventions must include latent capabilities while having the ability to be activated in place and scalable in order to accommodate the multiple potential threats and the many variables inherent with bioterrorism. The proposal for an architectural response to bioterrorism is situated in Washington, D.C., identified as the highest potential target city in the United States for acts of bioterrorism. Appropriate latent resources capable of acting as a part of the response network throughout the D.C. urban context will be identified and their potential activation will be explored through two example scenarios, which will be used to illustrate the proposed model for systematic response. The most architecturally significant locations for (activated) small scale interjections will be designed to meet the first response needs of the general population who would be moving about in the city during the detection of an event. These sites and features will allow for differing degrees of self-diagnosis during and following an event as well as provide general day to day and event related public health information. The proposed architectural interjections will be designed to respond to the predicted fear and panic exhibited by the walking well during a bioterrorist attack, and minimize their potential for overwhelming hospitals and other healthcare settings in the target region

EmergenSIG: an integrated location-based system for emergency management

Several solutions have been proposed for emergencies scenarios. These solutions include real-time data communication, location-aware, coordination, and decision-making support systems. In this context, this dissertation presents a location-awareness system fully oriented to emergency scenarios, called EmergenSIG. This approach provides and gathers important field information from an occurrence (emergency situation) and shares it to all the different agents. They include police, firefighters, medical emergency teams, among others, mobilized to the same operations theater (OT). Therefore, allowing a faster and integrated response to all the involved agents, enhancing the emergency management of the occurrence. The core of this proposal is based on a low cost solution oriented to the agents on the field (EmergenSIG mobile application), which interacts with the EmergenSIG Web application, oriented to the civil protection entities, through REST Web services. EmergenSIG focuses on medical emergencies and wildfires. It was evaluated and demonstrated in different mobile devices considering different screen sizes following a usercentered design. The system was also been evaluated and validated by real entities and civil protection agents on simulated emergency scenarios.Várias soluções têm sido propostas para cenários de emergências médicas . Estas soluções incluem comunicações de dados em tempo real ,sensíveis á localização , coordenação e sistemas de apoio à tomada de decisão. Neste contexto, esta dissertação apresenta um sistema sensível à localização totalmente orientada para cenários de emergência, chamada EmergenSIG. Esta abordagem proporciona e reúne importantes informações de uma ocorrência (situação de emergência) compartilhando-a para todos os diferentes agentes. Nos quais se incluem a polícia, bombeiros, equipas de emergência médica, entre outros, que se mobilizaram para o mesmo teatro de operações (TO). Portanto, permite uma resposta mais rápida e integrada para todos os agentes envolvidos, aumentando a eficácia da gestão da emergência de uma ocorrência. O cerne desta proposta é baseada numa solução de baixo custo direcionada para os agentes no terreno (aplicação móvel EmergenSIG), que interage com o aplicativo Web EmergenSIG, orientada para as entidades da proteção civil, através de serviços Web REST. O EmergenSIG centra-se em emergências médicas e incêndios florestais. Foi avaliada e demonstrada em diferentes dispositivos móveis, considerando diferentes tamanhos de ecrã e seguindo um design centrado no utilizador. O sistema também foi avaliado e validado por entidades reais e agentes da proteção civil em cenários de emergência simulados

Supply Chain Management Models To Improve The Impact Of Orthopaedic Equipment Donations

More than any other surgical subspecialty, orthopaedic surgery relies heavily on the use of implants and instruments, particularly in the provision of trauma related orthopaedic injuries, which are increasingly prevalent in low-income countries (LICs). The current international response to improving musculoskeletal care in LICs, is primarily geared towards increasing the donation of supplies used in orthopaedic surgical procedures. This study outlines the current response, and assesses the supply chain component of international aid efforts to improve fracture care. It then explores this component with a goal of determining how a sustainable source of functional implants can be delivered to skilled surgeons, to maximize the synergy of appropriate training and proper equipment towards delivering safe, simple and cost effective orthopaedic care in resource poor settings. There are two hypotheses: The first claims that the creation of a `coordinating unit\u27 authorized to manage the supply donation process and the stakeholders involved, will improve the delivery of musculoskeletal care in LICs. The second claims that the implementation of a virtual and physical supply chain platform will improve the delivery of musculoskeletal care in LICs. The hypotheses propose that a correlation exists between optimization of the donation process and the achievement of improved delivery of musculoskeletal care. The research methodology is qualitative, consisting of interviews and observations, field research, literature reviews and case studies. Study findings reveal that conducting local needs assessments, helping recipients identify and communicate demands, and confirming the presence of adequate local infrastructure and workforce capacity to receive and utilize donated equipment, are essential steps that should be executed prior to the deployment of donations, both within disaster and non- disaster contexts. In addition findings indicate that investment in logistical platforms and supply chains to manage donations, and establishment of a central coordinating unit to link stakeholders and information exchange, are highly instrumental in optimizing the provision of supplies and thus the delivery of orthopaedic care. The study results support the hypothesis that a `coordinating unit\u27 can provide a standard approach towards assessing need, capacity, and resource inventory, and can coordinate stakeholders in a manner that maximizes the use of individual and corporate donations, and supports the surgical capabilities of surgeons and healthcare workers delivering musculoskeletal care in LICs