The Current Crisis in Emergency Care and the Impact on Disaster Preparedness

<p>Abstract</p> <p>Background</p> <p>The Homeland Security Act (HSA) of 2002 provided for the designation of a critical infrastructure protection program. This ultimately led to the designation of emergency services as a targeted critical infrastructure. In the context of an evolving crisis in hospital-based emergency care, the extent to which federal funding has addressed disaster preparedness will be examined.</p> <p>Discussion</p> <p>After 9/11, federal plans, procedures and benchmarks were mandated to assure a unified, comprehensive disaster response, ranging from local to federal activation of resources. Nevertheless, insufficient federal funding has contributed to a long-standing counter-trend which has eroded emergency medical care. The causes are complex and multifactorial, but they have converged to present a severely overburdened system that regularly exceeds emergency capacity and capabilities. This constant acute overcrowding, felt in communities all across the country, indicates a nation at risk. Federal funding has not sufficiently prioritized the improvements necessary for an emergency care infrastructure that is critical for an all hazards response to disaster and terrorist emergencies.</p> <p>Summary</p> <p>Currently, the nation is unable to meet presidential preparedness mandates for emergency and disaster care. Federal funding strategies must therefore be re-prioritized and targeted in a way that reasonably and consistently follows need.</p

Review and Evaluation of the J100â 10 Risk and Resilience Management Standard for Water and Wastewater Systems

Risk analysis standards are often employed to protect critical infrastructures, which are vital to a nation’s security, economy, and safety of its citizens. We present an analysis framework for evaluating such standards and apply it to the J100â 10 risk analysis standard for water and wastewater systems. In doing so, we identify gaps between practices recommended in the standard and the state of the art. While individual processes found within infrastructure risk analysis standards have been evaluated in the past, we present a foundational review and focus specifically on water systems. By highlighting both the conceptual shortcomings and practical limitations, we aim to prioritize the shortcomings needed to be addressed. Key findings from this study include (1) risk definitions fail to address notions of uncertainty, (2) the sole use of â worst reasonable caseâ assumptions can lead to mischaracterizations of risk, (3) analysis of risk and resilience at the threatâ asset resolution ignores dependencies within the system, and (4) stakeholder values need to be assessed when balancing the tradeoffs between risk reduction and resilience enhancement.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154262/1/risa13421_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154262/2/risa13421.pd

Determinants of emergency response willingness in the local public health workforce by jurisdictional and scenario patterns: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>The all-hazards willingness to respond (WTR) of local public health personnel is critical to emergency preparedness. This study applied a threat-and efficacy-centered framework to characterize these workers' scenario and jurisdictional response willingness patterns toward a range of naturally-occurring and terrorism-related emergency scenarios.</p> <p>Methods</p> <p>Eight geographically diverse local health department (LHD) clusters (four urban and four rural) across the U.S. were recruited and administered an online survey about response willingness and related attitudes/beliefs toward four different public health emergency scenarios between April 2009 and June 2010 (66% response rate). Responses were dichotomized and analyzed using generalized linear multilevel mixed model analyses that also account for within-cluster and within-LHD correlations.</p> <p>Results</p> <p>Comparisons of rural to urban LHD workers showed statistically significant odds ratios (ORs) for WTR context across scenarios ranging from 1.5 to 2.4. When employees over 40 years old were compared to their younger counterparts, the ORs of WTR ranged from 1.27 to 1.58, and when females were compared to males, the ORs of WTR ranged from 0.57 to 0.61. Across the eight clusters, the percentage of workers indicating they would be unwilling to respond regardless of severity ranged from 14-28% for a weather event; 9-27% for pandemic influenza; 30-56% for a radiological 'dirty' bomb event; and 22-48% for an inhalational anthrax bioterrorism event. Efficacy was consistently identified as an important independent predictor of WTR.</p> <p>Conclusions</p> <p>Response willingness deficits in the local public health workforce pose a threat to all-hazards response capacity and health security. Local public health agencies and their stakeholders may incorporate key findings, including identified scenario-based willingness gaps and the importance of efficacy, as targets of preparedness curriculum development efforts and policies for enhancing response willingness. Reasons for an increased willingness in rural cohorts compared to urban cohorts should be further investigated in order to understand and develop methods for improving their overall response.</p

A transatlantic perspective on 20 emerging issues in biological engineering

Advances in biological engineering are likely to have substantial impacts on global society. To explore these potential impacts we ran a horizon scanning exercise to capture a range of perspectives on the opportunities and risks presented by biological engineering. We first identified 70 potential issues, and then used an iterative process to prioritise 20 issues that we considered to be emerging, to have potential global impact, and to be relatively unknown outside the field of biological engineering. The issues identified may be of interest to researchers, businesses and policy makers in sectors such as health, energy, agriculture and the environment

Challenging the Logics of Reformism and Humanism in Juvenile Justice Rhetoric

This article draws on contemporary policy discourse in order to advance claims about the intractable figure of the “bad” child in contemporary juvenile justice reforms in the United States (US). The article focuses in particular on the discourses of trauma and “brain science” to point to a form of neo-positivism that has arguably emerged and which challenges efforts to engage in systematic decarceration. The article also focuses on the idea of the “bad child” that persists in the commitment of some reformers to the necessity of confinement for some children. The article questions the extent to which new forms of positivism challenge our ability to leverage structural claims

Safe &amp; Secure Addressing Workplace Violence

Workplace violence entails any act or threat of violence, verbal abuse, or physical assaults towards individuals at work. This could arise from criminal intent, customer/client interactions, worker-on-worker disputes, or personal relationships. Industries dealing with the public, money handling, lone work, or operating in high-crime areas face elevated risk

Supply Chain Risks of Illicit Trade in Counterfeit Pharmaceuticals

Nearly every type of product that has ever been produced has been counterfeited. While the most counterfeited goods tend to be footwear, luxury items, watches, and jewelry, in recent years there has been a dramatic increase in the prevalence of pharmaceutical counterfeits. The World Health Organization (WHO) defines counterfeit medicines as “medicines that are mislabeled deliberately and fraudulently”, yet counterfeit medicines are generally discussed alongside other forms of harmful medical products such as adulterated, expired, substandard, stolen, and falsified medicines. Each of these products moves through a mix of illegitimate and legitimate intermediaries and distribution channels before making their way into healthcare systems and ultimately to patients. Counterfeit pharmaceuticals harm patients, the healthcare system, legitimate companies, and society. While their presence within the legitimate supply chain is increasing, the threats posed by these illicit goods can be countered through focused action and collaboration amongst industry, healthcare, and law enforcement. This paper discusses three primary risks to consumers and the healthcare infrastructure of Texas: (1) the infiltration of counterfeit drugs into the legitimate supply chain; (2) the direct threat posed by counterfeit pharmaceuticals; and (3) the risks posed by counterfeit drugs to national security and the legitimate supply chain. The paper concludes with a discussion of policy and anti-counterfeiting strategy recommendations aimed at addressing each of the identified risks and protecting Texans, Americans, and the healthcare supply chain

Improving Texas Homeland Security: A Practical Framework for Joint Hospital - Chemical Industry Emergency Planning

Given the high concentration of petroleum and chemical industry in Texas, a new approach to joint industry/hospital planning for the healthcare response to chemical accidents is needed. The novel aspect of this framework is that it applies the concepts of a chemical risk assessment – and a risk prioritization to readiness - and adds to the risk assessment process the need and availability of medical countermeasures. In treating chemical incidents, it is imperative that the patient get to the right hospital as quickly as possible. The right hospital means that the hospital has conducted joint planning and exercises with the industry. The hospital knows what chemicals are used at the plant, they know how to treat the injuries, and they have the correct medical countermeasures for the chemicals involved. To illustrate the importance of this concept, in a 1986 incident a plant worker was exposed to hydrogen fluoride gas. He was first transported to a nearby nursing home for oxygen. When this was not effective, he was transported to a small community hospital. When they realized they could not care for him he was again transported to a regional hospital that had the ability to treat the patient, but unfortunately too much time had passed, and the patient died shortly after arrival. If taken to the right hospital first, he would have survived

Enhanced Decision-Making Framework for the Southern States to Comply with the New Federal Retroreflectivity Pavement Rule

Retroreflectivity plays a crucial role in pavement markings as it enhances nighttime visibility for drivers. Yet, due to budget constraints, many state U.S agencies including the Texas Department of Transportation (TxDOT) rarely monitor the retroreflectivity of their markings, and instead, restripe their markings based on visual inspection or fixed schedule (every two years). Such a strategy is questionable in terms of safety as markings are usually restriped after the end of their service life. To address this issue, in August 2022, the Federal Highway Administration (FHWA) announced a new final rule that requires state agencies to implement a method within four years for maintaining pavement marking retroreflectivity at or above minimum levels. Hence, the key objective of this study was to develop a simple tool for TxDOT and other Southern state and local agencies to help them comply with the new federal rule. To do so, pavement marking data from the National Transportation Product Evaluation Program (NTPEP) were retrieved and analyzed. Results indicated that the service life of standard water-borne paints varies significantly from 0 to 3.9 years according to the project conditions. Hence, a performance prediction model was developed with superior accuracy to predict the expected service life of standard waterborne paints based on the initial retroreflectivity value, traffic level, and marking color. This model can be used by TxDOT and other southern state agencies to determine the expected restriping time before the retroreflectivity drop below the minimum threshold, and hence, comply with the new federal rule

Mitigating Cybersecurity Threats to Hospitals and Healthcare Facilities

Healthcare facilities rely heavily on digital information systems to deliver patient care and manage confidential patient information. However, healthcare networks and medical devices are highly vulnerable to attackers, who can use the information to victimize medical facilities as well as the patients themselves. The functioning of healthcare systems can be seriously impeded by cyberattacks, restricting information sharing among hospital personnel and delaying or preventing patient care. Although federal legislation and regulatory guidelines have been put forth to improve responses to cyberattacks and enhance patient information protections, the cybersecurity measures in place in many hospitals can be easily bypassed by motivated offenders via entry points in the facilities’ cybersecurity systems. In response to these threats to critical infrastructure, experts have proposed several risk mitigation strategies that healthcare facilities can employ to improve information technology systems and mitigate vulnerabilities associated with human factors. This report provides a summary of (1) the literature on the types and characteristics of cyberattacks most often perpetrated against healthcare providers, (2) the theory and research from criminology and criminal justice on the factors associated with cybercrime victimization risk, and (3) the best practices proposed by experts to help inform policymakers and healthcare professionals in Texas and nationwide