Equipment, Supplies and Pharmaceuticals: How Much Might it Cost to Achieve Basic Surge Capacity?

The ability to deliver optimal medical care in the setting of a disaster event, regardless of its cause, will in large part be contingent on an immediately available supply of key medical equipment, supplies, and pharmaceuticals. Although the Department of Health and Human Services Strategic National Stockpile program makes these available through its 12-hour “push packs” and vendor-managed inventory, every local community should be funded to create a local cache for these items. This report explores the funding requirements for this suggested approach. Furthermore, the response to a surge in demand for care will be contingent on keeping available staff close to the hospitals for a sustained period. A proposal for accomplishing this, with associated costs, is discussed as well

Role of Regional Healthcare Coalitions in Managing and Coordinating Disaster Response

A white paper prepared for the January 23-24, 2013 workshop on Nationwide Response to an Improvised Nuclear Device Attack, hosted by the Institute of Medicine’s Forum on Medical and Public Health Preparedness for Catastrophic Events together with the National Association of County and City Health Officials

Screening for Inhalational Anthrax Due to Bioterrorism: Evaluating Proposed Screening Protocols

Eleven known cases of bioterrorism-related inhalational anthrax (IA) were treated in the United States during 2001. We retrospectively compared 2 methods that have been proposed to screen for IA. The 2 screening protocols for IA were applied to the emergency department charts of patients who presented with possible signs or symptoms of IA at Inova Fairfax Hospital (Falls Church, Virginia) from 20 October 2001 through 3 November 2001. The Mayer criteria would have screened 4 patients (0.4%; 95% CI, 0.1%-0.9%) and generated charges of 1900 dollars. If 29 patients (2.6%; 95% CI, 1.7%-3.7%) with \u3eor=5 symptoms (but without fever and tachycardia) were screened, charges were 13,325 dollars. The Hupert criteria would have screened 273 patients (24%; 95% CI, 22%-27%) and generated charges of 126,025 dollars. In this outbreak of bioterrorism-related IA, applying the Mayer criteria would have identified both patients with IA and would have generated fewer charges than applying the Hupert criteria

Radiation Injury After a Nuclear Detonation: Medical Consequences and the Need for Scarce Resources Allocation

A 10-kiloton (kT) nuclear detonation within a US city could expose hundreds of thousands of people to radiation. The Scarce Resources for a Nuclear Detonation Project was undertaken to guide community planning and response in the aftermath of a nuclear detonation, when demand will greatly exceed available resources. This article reviews the pertinent literature on radiation injuries from human exposures and animal models to provide a foundation for the triage and management approaches outlined in this special issue. Whole-body doses \u3e2 Gy can produce clinically significant acute radiation syndrome (ARS), which classically involves the hematologic, gastrointestinal, cutaneous, and cardiovascular/central nervous systems. The severity and presentation of ARS are affected by several factors, including radiation dose and dose rate, interindividual variability in radiation response, type of radiation (eg, gamma alone, gamma plus neutrons), partial-body shielding, and possibly age, sex, and certain preexisting medical conditions. The combination of radiation with trauma, burns, or both (ie, combined injury) confers a worse prognosis than the same dose of radiation alone. Supportive care measures, including fluid support, antibiotics, and possibly myeloid cytokines (eg, granulocyte colony-stimulating factor), can improve the prognosis for some irradiated casualties. Finally, expert guidance and surge capacity for casualties with ARS are available from the Radiation Emergency Medical Management Web site and the Radiation Injury Treatment Network

When the Bells Toll: Engaging Healthcare Providers in Catastrophic Disaster Response Planning

Catastrophic disaster planning and response have been impeded by the inability to better coordinate the many components of the emergency response system. Healthcare providers in particular have remained on the periphery of such planning because of a variety of real or perceived barriers. Although hospitals and healthcare systems have worked successfully to develop surge capacity and capability, less successful have been the attempts to inculcate such planning in the private practice medical community. Implementation of a systems approach to catastrophic disaster planning that incorporates healthcare provider participation and engagement as one of the first steps toward such efforts will be of significant importance in ensuring that a comprehensive and successful emergency response will ensue

Alternate Care Systems: Stratification of Care

The following is a white paper prepared for the June 10–11, 2009, workshop on medical surge capacity, hosted by the Institute of Medicine Forum on Medical and Public Health Preparedness for Catastrophic Events. Dr Dan Hanfling discusses implementing a model of stratified care in a disaster, moving medical surge capacity planning beyond the hospital, and potential areas of future funding priorities

Aircrash Preparedness and Response

Article on aircrash preparedness and response under chapter heading Events Associated with Structural Collapse/Crashing/Crushing in book Disaster Medicine, 1 edition

Hospitals and the Novel H1N1 Outbreak: The Mouse That Roared?

With so much effort directed during the past few years toward pandemic influenza preparedness, especially toward H5N1 avian influenza, the rapid emergence of a novel H1N1 (nH1N1) influenza strain was met with a certain matter-of-fact acceptance by hospital and health care planners in April 2009. Emergency planners have long parroted the phrase “not if, but when,” and so it became immediately clear that “when” had reared its head again. Yet, as mortality rates and epidemiology became clearer, the sense of urgency declined in many health care–related agencies, organizations, and facilities. As pandemics go, this seemed to be a mouse among lions

Preparing for Pandemic Influenza: Adapting a Model of Healthcare Facility Preparedness to the Business Sector

With concerns that another influenza pandemic is drawing near, viral strains of which might be circulating across wild bird populations in Asia, North Africa and Europe at the present time, the business sector has begun to focus attention on the steps required to prepare for such an eventuality. This paper elucidates the translation of an \u27all-hazards\u27 healthcare sector model established in the wake of response to the significant terrorist events in the autumn of 2001 for use in the business setting. The model is based upon the identification and promotion of strong leadership, implementation of sound infection control and occupational health and safety measures, development of a comprehensive training and education programme, and the proactive institution of business recovery practices

National Preparedness for a Catastrophic Emergency: Crisis Standards of Care

Public health emergencies underscore the immediate and crucial need to plan for a mass disaster in which tens or even hundreds of thousands of individuals suddenly require medical care. On October 24, 2009, President Obama declared a public health emergency in response to influenza A(H1N1),1 but natural disasters (eg, hurricanes, floods, or earthquakes) and terrorism acts (eg, anthrax or a nuclear detonation) similarly demonstrate the critical need for national preparedness