571 research outputs found

    Smallpox Bioterrorism Preparedness: The Importance of Technology and Education for Early Detection and Response

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    The use of biological agents as weapons has been prevalent throughout history. Only when the US experienced a bioterrorist attack in 2001 did additional funding begin to invest in preparing for other potential attacks. These initial investments, along with others, have funded preventative measures such as mass surveillance through biosensor technology and the development of preparedness programs such as the Laboratory Response Network and Hospital Preparedness Program. Based on learnings from previous outbreak events, in the event of a bioterrorist attack involving smallpox early detection will be the key to initiating a rapid and effective response. Additionally, further measures need to be taken to detect smallpox release either in the form of lab modified pathogens or laboratory compromise. Technologies must be made more accessible especially in rural areas where access may be limited. Because access may be limited, investments must be made into programs to better train medical personnel in identifying smallpox. This education must include topics not only on how to identify potential cases and management, but include topics related to identifying available resources and correct use of personal protection equipment to prevent further infection. Based on research, this education would improve healthcare personnel’s willingness to respond during an attack to improve containment. Finally, preparing education for the public prior to an event is important as they can assist in early identification and reduce panic. Improving bioterrorist attack readiness involving smallpox in the above areas is the key for reducing morbidity, mortality, and its overall impact on public health

    Bioterrorisrn Preparedness of Rural Hospitals Compared to Urban Hospitals in Minnesota

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    Bioterrorisrn has been a threat to many cultures around the world for centuries. The first record of their use dates back to 184 B.C. in a battle between Hannibal and King Eumenes of Peranum. Within the past five years, the concern over biological weapons and bioterrorism has greatly increased in the United States because of worldwide political dynamics. Is the United States prepared for a bioterrorism attack? Is Minnesota prepared for an attack? These are important questions, and many experts have not agreed upon the answers. Currently there is no industry standard for hospitals in regards to bioterrorisrn preparedness. Utilizing data from a survey of Minnesota hospitals conducted by the Minnesota Department of Health in 2002, this study compared rural and urban hospitals in Minnesota and their level of bioterrorisrn preparedness. From the data, no overall statistical difference was found between rural and urban hospitals. It became clear, however, that there existed a need for improved preparedness in all Minnesota hospitals. Additionally, there was a need for an industry standard for minimal preparedness and the resources to help hospitals attain and maintain that level of preparedness

    Bioterrorism: Exploring Factors for Improving Nurse Preparedness, Policies, and Practices

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    Ebola virus release/attack in New Jersey could go unnoticed but have immediate and long-lasting effects on the broader population and security. The risk underscores the need to prepare and enhance the state’s efforts to deal with a release and treat the confirmed cases. This descriptive single case research explored factors for improving nurses’ preparedness, policies, and practices for a bioterrorism release/attack. The epidemiological triangle conceptual framework was used descriptively in exploring, and developing a knowledge base of Ebola virus pathogenicity, characteristics, routes of transmission, and infection. The unit of analysis was Summit Ridge Genesis Healthcare Center. The theory of robust transformation provided structure for this study. Data were collected from studies on bioterrorism, U.S. government bioterrorism policies, and the interview site’s bioterrorism protocol, including nurse interviews and participant observation. A pattern matching technique was used for analyzing data. The healthcare facility has the capacity and human resources to prepare and deal with the public health challenges posed by Ebola. Recommendations based on the study results include that the site train nurses of biological agents preparedness and to conduct table-top and functional exercises. The instructive social change implicit in this study has significant implications for New Jersey policymakers, the facility leadership, and nurses in preparing for a possible Ebola terrorism attack

    Using Computer Simulation Modeling To Evaluate The Bioterrorismresponse Plan At A Local Hospital Facility

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    The terrorist attacks of September 11th, 2001 and the subsequent anthrax mail attack have forced health care administrators and policy makers to place a new emphasis on disaster planning at hospital facilities--specifically bioterrorism planning. Yet how does one truly prepare for the unpredictable? In spite of accreditation requirements, which demand hospitals put in to place preparations to deal with bioterrorism events, a recent study from the General Accounting Office (GAO) concluded that most hospitals are still not capable of dealing with such threats (Gonzalez, 2004). This dissertation uses computer simulation modeling to test the effectiveness of bioterrorism planning at a local hospital facility in Central Florida, Winter Park Memorial Hospital. It is limited to the response plan developed by the hospital\u27s Emergency Department. It evaluates the plan\u27s effectiveness in dealing with an inhalational anthrax attack. Using Arena computer simulation software, and grounded within the theoretical framework of Complexity Science, we were able to test the effectiveness of the response plan in relation to Emergency Department bed capacity. Our results indicated that the response plan\u27s flexibility was able to accommodate an increased patient load due to an attack, including an influx of the worried well. Topics of future work and study are proposed

    Reliability and validity of EMS dispatch code-based categorization of emergency patients for syndromic surveillance.

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    A retrospective study involving the secondary analysis of public health surveillance records was undertaken to characterize the reliability and validity of an EMS dispatch data-based scheme for assigning emergency patients to surveillance syndromes in relation to two other schemes, one based on hospital ED clinicians\u27 manual categorization according to patients\u27 chief complaint and clinical presentation, and one based on ICD-9 coded hospital ED diagnoses. Comparisons of a sample of individual emergency patients\u27 syndrome assignments according to the EMS versus each of the two hospital categorization schemes were made by matching EMS run records to their corresponding emergency department patient encounter records. This new, linked dataset was analyzed to assess the level of agreement beyond chance between the three possible pairs of syndrome categorization schemes in assigning patients to a respiratory or non-respiratory syndrome and to a gastrointestinal or non-gastrointestinal syndrome. Cohen\u27s kappa statistics were used to measure chance-adjusted agreement between categorization schemes (raters). Z-tests and a chi-square-like test based on the variance of the kappa statistic were used to test the equivalence of kappa coefficients across syndromes, population subgroups and pairs of syndrome assignment schemes. The sensitivity, specificity, predictive value positive and predictive value negative of EMS dispatch and chief complaint-based categorization schemes were also calculated, using the ICD-9-coded ED diagnosis-based categorization scheme as the criterion standard. Comparisons of all performance characteristic (i.e. sensitivity, specificity, predictive value positive and predictive value negative) values were made across categorization schemes and surveillance syndromes to determine whether they were significantly different. The use of EMS dispatch codes for assigning emergency patients to surveillance syndromes was found to have limited but statistically significant reliability in relation to more commonly used syndrome grouping methods based on chief complaints or ICD-9 coded ED diagnoses. The reliability of EMS-based syndrome assignment varied significantly by syndrome, age group and comparison rater. When ICD-9 coded ED diagnosis-based grouping is taken as the criterion standard of syndrome definition, the validity of EMS-based syndrome assignment was limited but comparable to chief complaint-based assignment. The validity of EMS-based syndrome assignment varied significantly by syndrome

    Bio+Terror: Science, Security, Simulation

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    The United States government has spent more than $125 billion since 2001 to prepare the nation for bioterrorism. This dissertation examines the emergence of bioterrorism as a credible threat in the contemporary moment, considering how the preparedness practices of the security state constitute new biopolitical formations. To explore how changing ways of knowing disease and risk are reshaping communities, this multi-sited study investigates the material outcomes of biosecurity in people\u27s lives. It shows how complex histories of disease and terror are remade in the modern age to bring about new spaces and forms of biological citizenship.Through interview, observation and detailed historical research, this research considers three sites where bioterrorism is reshaping public life. At Montana\u27s Rocky Mountain Laboratory, the community protest of the first high-security Biosafety Level-4 facility built in the 21st century exemplifies how public fear of microbes reshapes laboratory spaces and constructs environmental geographies around new conceptions of life, risk, and disease. The creation and implementation of new biopreparedness programs at the Centers for Disease Control and Prevention in Atlanta show how the alliance of public health practices with the nation\u27s security complex brings a new level of militarism to everyday practices of health and wellness. Finally, a case study of bioterrorism simulation exercises in New Mexico considers how the public rehearsal of terrorism events creates a perpetual state of emergency as governments and citizens publicly perform their responses to a crisis.By studying the technoscientific extensions of war in the modern age, this research questions how the care-giving acts of governance have been militarized and how enlisting the bioscience industry in the War on Terror is changing societal norms of knowing life, death, nature, and disease, grounded in these re-articulations of life itself. The emerging spaces and economies of terrorism preparedness exemplify how the fusion of new genomic biologies with national security practices brings material change to the spaces where people live and work. This research aims to convince scholars as well as policymakers and activists that the ways in which bioterrorism has been produced have consequences in how people live

    Prioritizing Patients for Emergency Evacuation From a Healthcare Facility

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    The success of a healthcare facility evacuation depends on communication and decision-making at all levels of the organization, from the coordinators at incident command to the clinical staff who actually carry out the evacuation. One key decision is the order in which each patient is chosen for evacuation. While the typical planning assumption is that all patients are to be evacuated, there may not always be adequate time or resources available to move all patients. In these cases, prioritizing or ordering patients for evacuation becomes an extremely difficult decision to make. These decisions should be based on the current state of the facility, but without knowledge of the current patient roster or available resources, these decisions may not be as beneficial as possible. Healthcare facilities usually consider evacuation a last-resort measure, and there are often system redundancies in place to protect against having to completely evacuate all patients from a facility. Perhaps this is why there is not a great deal of research dedicated to improving patient transfers. In addition, the question of patient prioritization is a highly ethical one. Based on a literature review of 1) suggested patient prioritization strategies for evacuation planning as well as 2) the actual priorities given in actual facility evacuations indicates there is a lack of consensus as to whether critical or non-critical care patients should be moved away from a facility first in the event of a complete emergency evacuation. In addition, these policies are \u27all-or-nothing\u27 policies, implying that once a patient group is given priority, this entire group will be completely evacuated before any patients from the other group are transferred. That is, if critical care patients are given priority, all critical care patients will be transferred away from the facility before any non-critical care patient. The goal of this research is to develop a decision framework for prioritizing patient evacuations, where unique classifications of patient health, rates of evacuation, and survivability all impact the choice. First, I provide several scenarios (both in terms of physical processing estimates as well as competing, ethically-motivated objectives) and offer insights and observations into the creation of a prioritization policy via dynamic programming. Dynamic programming is a problem-solving technique to recursively optimize a series of decisions. The results of the dynamic programming provide optimal prioritization policies, and these are tested with simulation analysis to observe system performance under many of the same scenarios. Because the dynamic programming decisions are based on the state of the system, simulation also allows the testing of time-based decisions. The results from the dynamic programming and simulation, as well as the structural properties of the simulation are used to create assumptions about how evacuations could be improved. The question is not whether patient priorities should be assigned - but how patient priorities should be assigned. Associated with assigning value to patients are a variety of ethical dilemmas. In this research, I attempt to address patient prioritization from an ethical perspective by discussing the basic principles and the potential dilemmas associated with such decisions. The results indicate that an all-or-nothing, or a \u27greedy\u27 policy as discussed in the literature may not always be optimal for patient evacuations. In some cases, a switching policy may occur. Switching policies begin by evacuating patients from one classification and then switch to begin evacuations from the second patient class. A switch can only be made once; after a switch is made, all remaining patients from the new group should be evacuated. When there are no more patients of that group remaining in the system, the remaining patients from the class that was initially given priority should be evacuated. In the case of critical and non-critical care patients, switching policies first give priority to non-critical care patients. When the costs of holding patients in the system are not included in the models - and the decisions are just based on maximizing the number of saved lives - the switching policies may perform as good or better than the greedy policies suggested in the literature. In addition, when holding costs are not included, it is easier to predict whether the optimal policy is a greedy policy or a switching policy. Prioritization policies can change based on the utility achieved from evacuating individual patients from each class, as well as for other competing objective functions. This research examines a variety of scenarios - maximizing saved lives, minimizing costs, etc. - and provides insights on how the selection of an objective impacts the choice. Another insight of this research is how multiple evacuation teams should be allocated to patients. In the event that there is more than one evacuation team dedicated to moving a group of patients, the two teams should be allocated to the same patient group instead of being split between the multiple patient groups

    Disaster Education for Nurses: A Comparison of Two Instructional Methods for Teaching Basic Disaster Life Support in the Light of Self-Efficacy Theory

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    Abstract Nurses constitute the largest group in the healthcare workforce and are called on to assist in emergencies such as disasters. Research has shown that professionals with higher levels of knowledge are more likely to respond to actual emergencies. Yet most hospital based nurses do not possess the skills needed for disaster response. The Basic Disaster Life Support (BDLS) course, with its comprehensive content, represents the gold standard for disaster education. Since confidence also plays a role in response, a tool to measure this variable could be useful. There were five purposes of this study: determine whether one teaching method (computer or classroom instructor-led) is superior over another for disaster education; evaluate how knowledge retention varies between instructional models; examine whether a correlation exists between self-efficacy and disaster knowledge; pilot a new instrument, Disaster Self-Efficacy Scale (DSES); complete psychometrics on the Basic Disaster Life Support exam. The study was an experimental pretest/posttest/follow-up with a single between-group factor (type of training with three levels) and three within-group factors measured at three intervals. The sample included 82 hospital-based nurses randomly assigned to a computer-based, instructor-led, or control group. A MANOVA and MANCOVA were conducted to evaluate group differences at three time intervals. Psychometric evaluation was conducted on both the BDLS and the piloted Disaster Self-Efficacy measures. The BDLS test was shown to be in need of revisions and updating. The DSES measure shows promise for determining disaster self-efficacy and may be useful to target training though it needs further validation. Learning results showed that when controlling for pretest differences, experimental groups had higher posttest BDLS and DSES scores than the control group but there was no difference between experimental groups. There was no difference between experimental groups for BDLS scores at follow-up. Conclusions were that training, regardless of how it was delivered, led to a dramatic increase in disaster knowledge and disaster self-efficacy; computer-based education is a feasible alternative to teaching BDLS; retention still poses a challenge for disaster education. Implications for nursing education and practice were identified. Future research should focus on further development and validation of the DSES and BDLS instruments

    RCHE Semi-Annual Report June 2013

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