Are EMS Prepared to Respond to a Pandemic or Bioterrorist Attack?

The 2019 Coronavirus (COVID-19) pandemic increased America’s awareness of the amount of death and damage to the economy that pandemics and bioterrorism can cause. Additionally, the COVID-19 pandemic exposed significant shortfalls in national preparedness for a pandemic or bioterrorism event. The purpose of this study is to evaluate the current preparedness level of Emergency Medical Services (EMS) personnel in the United States to prepare for, respond to, mitigate, and recover from a natural or manufactured pandemic across the United States. The significance of this study is an accurate picture of preparedness for pandemic and bioterrorism events by American EMS systems. This preparedness level can be compared to the desired preparedness posture to address the delta between desired and observed preparedness. The theoretical foundation for this quantitative research project was based on multiple streams theory and utilized descriptive and inferential statistics. The research questions focused on the current preparedness of EMS providers to effectively respond to a pandemic or bioterrorist attack and possible improvements to current EMS practices that would improve the effectiveness of future responses. The study population consisted of 398 (N – 398) individual and currently credentialed EMS providers representing various prehospital certification levels from all types of EMS systems through an electronic standardized ethically reviewed questionnaire. A chi-square test of statistical significance and inferential statistical analysis revealed a statistically significant difference in the perception of EMS providers in various demographic categories and their perception of preparedness to respond to a pandemic or bioterrorist attack

Disaster management and its economic implications

Das Ziel dieser Arbeit ist es, aktuelle Forschungsschwerpunkte im Bereich des Katastrophenmanagements in der Operational Research Literatur aufzuzeigen. Katastrophenmanagement umfasst in diesem Zusammenhang einerseits Naturkatastrophen wie geophysikalische und hydro-meteorologische Katastrophen, technologische Katastrophen wie industrielle Unfälle, Transportunfälle und sonstige Unfälle, und andererseits die verschiedenen Formen des Terrorismus, allgemeinen Terrorismus sowie Bioterrorismus. Da die Anzahl und das Ausmaß von Katastrophen immer weiter zunehmen ist auch eine immer größere Notwendigkeit für die Entwicklung, den Einsatz und die wirtschaftliche Beurteilung der jeweiligen Strategien gegeben. Der erste Teil dieser Arbeit gibt einen Überblick über die Literatur im Bereich des Katastrophenmanagements und umfasst Simulation, Katastrophenmanagement in Krankenhäusern und die Rolle von Versicherungen im Katastrophenmanagementprozess. Im zweiten Teil wird eine Taxonomie entwickelt, deren Kategorien auf den Modellen und Ergebnissen der Literatur beruhen. Einerseits werden allgemeine Modelleigenschaften wie die Ebene im Katastrophenmanagementprozess, der Modelltyp und die Anwendungsgebiete der Modelle untersucht. Andererseits stellen die Art der Intervention und die Anwendbarkeit für die unterschiedlichen Katastrophenklassen weitere Kategorien der Taxonomie dar. Es wurden 90 Artikel, die beispielhaft für die Forschungsrichtungen im Bereich des Katastrophenmanagements der letzten 25 Jahre stehen, ausgewählt, und entsprechend den jeweiligen Kategorien der Taxonomie zugeordnet. Das Hauptaugenmerk der Taxonomie liegt auf der wirtschaftlichen Analyse, die wirksamkeitsbezogene, ressourcenbezogene und kostenbezogene Parameter umfasst. Es wird gezeigt ob und welche wirtschaftliche Analyse wie beispielsweise die Kosten-Nutzwert- Analyse, die Kosten-Wirksamkeits-Analyse und die Kosten-Nutzen-Analyse angewendet wird um die in den Artikeln beschriebenen Interventionen zu evaluieren. Es wird gezeigt, dass erhebliche Verbesserungen für die verschiedenen Katastrophentypen und in den verschiedenen Situationen erzielt werden können. Eingeschränkte Datenverfügbarkeit schränkt in vielen Fällen die Einsetzbarkeit der Modelle in realen Situationen ein. Im Allgemeinen ist erkennbar, dass Kooperation und Koordination zwischen den beteiligten Einheiten ausschlaggebend für den zeitgerechten und effizienten Einsatz der knappen Ressourcen sind. Oftmals erzielt der gemeinsame Einsatz mehrerer Maßnahme ein deutlich besseres Ergebnis als der Einsatz von lediglich einem einzigen Instrument. Die Taxonomie unterstreicht dass trotz der großen Fülle an Literatur im Bereich des Katastrophenmanagements nur wenige Autoren auf die Kosten-Nutzwert-Analyse, die Kosten-Wirksamkeits-Analyse und die Kosten-Nutzen-Analyse als Hilfsmittel zur wirtschaftlichen Analyse zurückgreifen. In Zukunft, um Interventionen erfolgreich evaluieren zu können oder die beste aus mehreren Interventionen bestimmen zu können wird es immer wichtiger werden, diese Art von wirtschaftlichen Analysen anzuwenden.This thesis intends to demonstrate current research directions in the field of disaster management in the Operational Research literature. Disaster management in this context comprises the management of natural, such as geophysical and hydro-meteorological, and technological disasters, such as industrial accidents, transportation accidents, and miscellaneous accidents, as well as the management of the different terrorism forms, general terrorism and bioterrorism. As the occurrence of disasters is getting more and more frequent and the accumulated loss of these events is getting higher and higher, there is a strong need for the development, implication and economic evaluation of strategies to counter these disasters. In the first part of the thesis, a general overview of the literature is given, including a focus on simulation, disaster management in hospitals, and the role of insurances in the disaster management process. The second part encompasses the taxonomy which focuses on models and outcomes presented in the literature. As a result of the review of the literature, appropriate categories for the disaster management taxonomy are derived. On the one hand, an overview of general model features, i.e., the level of disaster management, model type and methods of application is given. On the other hand, the type of intervention used and the practicability for different disaster types are discussed. 90 papers, illustrative main examples of the research directions of the last 25 years, were selected for deeper investigation and classified according to the main criteria analyzed in the articles. The main focus of the taxonomy lies on the economic analysis, which encompasses effectiveness-related, resource-related, and cost-related parameters and shows the type of economic analysis used in the literature. We analyze whether economic analysis, i.e., costutility, cost-effectiveness, and cost-benefit are used to investigate different interventions and what type of analysis has been chosen by the authors. Policy implications and results show that considerable improvements can be achieved for different disastrous events and in different situations. Limited data availability constrains the outcomes of the models and their applicability to real-world situations. In general, cooperation and coordination of the entities involved are crucial to guarantee timely and efficient assignment of scarce resources. Furthermore, different authors confirm that a combination of various measures often achieves a better outcome than if tools are used autonomously. The taxonomy has underlined that although there exists a vast disaster management literature dealing with various problems related to mitigation, preparedness, response and recovery from disasters, there are only a few authors evaluating the actions taken through economic analyses such cost-utility, cost-effectiveness, or cost-benefit analysis. In the future, to be able to evaluate interventions, or to figure out the most effective intervention among several interventions, it is crucial to stronger rely on the abovementioned economic analyses

Ready or Not? Protecting the Public's Health From Diseases, Disasters, and Bioterrorism, 2008

Examines ten indicators to assess progress in state readiness to respond to bioterrorism and other public health emergencies. Evaluates the federal government's and hospitals' preparedness. Makes suggestions for funding, restructuring, and other reforms

Ready or Not? Protecting the Public's Health From Diseases, Disasters, and Bioterrorism, 2009

Based on ten indicators, assesses progress in the readiness of states, federal government, and hospitals to respond to public health emergencies, with a focus on the H1N1 flu. Outlines improvements and concerns in funding, accountability, and other areas

Knowledge, attitudes and practices of health care workers regarding disaster preparedness at Johannesburg hospital in Gauteng Province, South Africa

M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2008.The purpose of the study is to ascertain the knowledge, attitudes and practices of hospital management at the Johannesburg Hospital regarding disaster preparedness. Objectives: The study is to assess the current status of awareness of the management regarding disaster preparedness; to determine whether there are hospital specific plans; knowledge of whether the plans are regularly updated or not; to determine attitudes towards disaster management plans and drills and to determine current practices with regards to disaster preparedness . Study design: The study design was a cross sectional survey. The study population included the hospital administrators, head of clinical units, head of casualties, the chief porter, the chief clerk, the theatre matron, senior sisters and doctors in the casualty department, head of security, head of transport and the chief pharmacist The study was conducted utilizing a self administered questionnaire with structured and open ended questions. In case where management were not available, the person acting in that capacity was requested to complete the questionnaire. Twenty five out of the thirty five managers selected completed a self administered questionnaire. The response rate was 71,4%. Findings: The management at the Johannesburg Hospital was aware of the disaster preparedness of the hospital and its plans, and disaster management preparedness. Their attitudes to the plans and drill were largely positive. However, the practices were deficient and work still needs to be done in regard to ongoing training, performance of drills and the frequency of regular updating of the plans

The Influences Of System Affiliation, Size, And Location On Bioterrorism Preparedness Among Florida Hospitals

In the event of a bioterrorist attack, emergency departments are considered the first line of response for all acute levels of care. This study focused on hospital emergency departments in Florida and the activities, policies, and procedures involved in preparing for a bioterrorist attack. Hospital size, location, and system affiliation were related to attaining these levels, and their impact was assessed. Through a cross-sectional survey design, the physical properties of the 77 hospitals (i.e. facilities, equipment, communication systems, etc.), and the social characteristics of the organizations (managerial functions including: planning, training, financial, and environmental characteristics) were examined. One-way analysis of variance and t-tests revealed that bed size was a significant predictor of mean levels of preparedness. In addition, although more hospitals are conducting training activities, a disconnect between plans and communications of said plans still exists along with many deficiencies still needing to be corrected. Study limitations are discussed and important policy implications are presented. Suggestions for improving preparedness levels and implementing new policies include: conducting training exercises, developing community ties and mutual aid agreements, and using information technology with detection of an event and communication of the information garnered from these efforts

Graph Matching Based Decision Support Tools For Mitigating Spread Of Infectious Diseases Like H1N1

Diseases like H1N1 can be prevented from becoming a wide spread epidemic through timely detection and containment measures. Similarity of H1N1 symptoms to any common flu and its alarming rate of spread through animals and humans complicate the deployment of such strategies. We use dynamic implementation of graph matching methods to overcome these challenges. Specifically, we formulate a mixed integer programming model (MIP) that analyzes patient symptom data available at hospitals to generate patient graph match scores. Successful matches are then used to update counters that generate alerts to the Public Health Department when the counters surpass the threshold values. Since multiple factors like age, health status, etc., influence vulnerability of exposed population and severity of those already infected, a heuristic that dynamically updates patient graph match scores based on the values of these factors is developed. To better understand the gravity of the situation at hand and achieve timely containment, the rate of infection and size of infected population in a specific region needs to be estimated. To this effect, we propose an algorithm that clusters the hospitals in a region based on the population they serve. Hospitals grouped together affect counters that are local to the population they serve. Analysis of graph match scores and counter values specific to the cluster helps identify the region that needs containment attention and determine the size and severity of infection in that region. We demonstrate the application of our models via a case study on emergency department patients arriving at hospitals in Buffalo, NY

Concurrent Biological, Electromagnetic Pulse, And Cyber Attacks - A Challenge To The Interagency Response

The U.S. including its military depends on an electrical grid and electricity-based critical infrastructure. An electromagnetic pulse (EMP) and cyber attack can disable not just a significant portion of the electrical grid and critical infrastructure, but also the networkcentric military response to such an attack. There is a large range of actors that might attempt EMP attacks against the U.S.. Health surveillance systems are network-centric, and if mass destruction is the goal of an adversary, launching a biological attack concurrently with EMP and cyber attacks may achieve this goal. Current agency response plans focus on one WMD attack at a time but combined attacks without emergency management plans may compromise a timely response. An EMP and cyber attack could amplify the effects of a biological attack because the loss of the electrical grid and electricity-based critical infrastructure could disable detection and response efforts as well as disrupt interagency efforts to coordinate a medical response. EMP is often perceived as science fiction because the immediate effect does not result in loss of life, but the cascading failures of critical infrastructure will affect civilian and military capabilities to support survival and recovery. Key steps to mitigate the catastrophic effects of an EMP attack should be taken and include: prevent an attack in the first place, prepare so personnel can respond after an attack, protect the critical infrastructure to limit the impact, and recover after an attack to restore power and critical infrastructure

A Simulation Based Study in a Hospital Emergency Department: Capacity and Workflow Issues

Emergency departments’ capacities to deal with a patient surge (the number of patients increases in a short period of time) play an important role in preparedness for natural or man-made disasters. This paper examines how emergency departments could improve their capacities by optimizing the workflow. A framework is proposed to reconfigure the workflow to improve capacity while maintaining treatment equality. Our results show that reducing lower priority processes and combining originally separate processes can shorten patient total waiting time in the emergency department

FORCEnet an analysis of the Trident Warrior 2003 exercise

Since the country has moved into the Information Age, the military forces have been moving towards network based operations. The rapid expansion of the internet and information technology (IT) has led to the emerging theory of Network- Centric Warfare (NCW). The Naval Services instantiation of NCW is FORCEnet. "FORCEnet is the "glue" that binds together Sea Strike, Sea Shield, and Sea Basing. It is the operational construct and architectural framework for naval warfare in the Information Age, integrating warriors, sensors, command and control, platforms, and weapons into a networked, distributed combat force. FORCEnet will provide the architecture to increase substantially combat capabilities through aligned and integrated systems, functions, and missions. Sea Power 21 is a comprehensive attempt to address the ramifications of the Information Age revolution. The framework of the Sea Power 21 vision is composed of the following elements: Sea Basing, Sea Shield and Sea Strike. The enabler of this vision or the "glue" that holds it all together is FORCEnet. FORCEnet is "the operational construct and architectural framework of naval warfare in the information age that integrates Warriors, sensors, networks, command and control, platforms, and weapons into a networked, distributed combat force that is scaleable across all levels of conflict from seabed to space and sea to land." The Trident Warrior 03 exercise was then developed as a means to measure its success and to acquire data from which future exercises can be measured against. FORCEnet is still in its infancy and many people have different views on what exactly it is and how it should be implemented to achieve those goals. The intent of this thesis was not to answer those questions per se, but provide a realistic analysis of what worked during the TW03 exercise and what did not. This should provide a baseline for further Trident Warrior exercises so as to avoid the same mistakes in the future. The military has a ways to go before it can fully realize a truly networked-centric armed forces, but TW03 was the beginning and the lessons learned from it will pay dividends in realizing that fully networked goal.http://archive.org/details/forcenetnnalysis109451392Major, United States Marine CorpsApproved for public release; distribution is unlimited