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Adequate and effective emergency preparedness for hospital surge capacity is a prerequisite to ensuring standard healthcare services for disaster victims. This study aimed to identify, review, and synthesize the preparedness activities for and the barriers to hospital surge capacity in disasters and emergencies. We systematically searched seven databases (PubMed, MEDLINE, CINAHL, Scopus, Embase, Ovid, and PsycINFO). We included all English peer-reviewed studies published in January 2016 and July 2022 on surge capacity preparedness in hospital settings. Two independent researchers screened titles and abstracts, reviewed the full texts, and conducted data extractions using CADIMA software. We assessed the rigor of the included studies using the NIH quality assessment tools for quantitative studies, the Noyes et al. guidelines for qualitative studies, and the MMAT tool for mixed methods studies and summarized findings using the narrative synthesis method. We also used PRISMA reporting guidelines. From the 2560 studies identified, we finally include 13 peer-reviewed studies: 10 quantitative, one qualitative, and two mixed methods. Five studies were done in the USA, three in Iran (n = 3), and the remaining in Australia, Pakistan, Sweden, Taiwan, and Tanzania. The study identified various ways to increase hospital surge capacity preparedness in all four domains (staff , stuff , space , and system); among them, the use of the Hospital Medical Surge Preparedness Index and the Surge Simulation Tool for surge planning was noteworthy. Moreover, nine studies (69%) recognized several barriers to hospital surge capacity preparedness. The review provides synthesized evidence of contemporary literature on strategies for and barriers to hospital surge capacity preparedness. Despite the risk of selection bias due to the omission of gray literature, the study findings could help hospital authorities, public health workers, and policymakers to develop effective plans and programs for improving hospital surge capacity preparedness with actions, such as enhancing coordination, new or adapted flows of patients, disaster planning implementation, or the development of specific tools for surge capacity. PROSPERO CRD42022360332. [ABSTRACT FROM AUTHOR]

There emerges increasing doubt regarding whether the policy composite indicators are applicable to the COVID-19 pandemic. A few early studies demonstrate that the association between some composite indicators of policy preparedness and the risk of COVID-19 is statistically insignificant, and the relation between any composite indicators and recovery process (e.g., vaccination coverage) remains unexplored. To examine the relation between composite indicators and pandemic risk (as well as the vaccination coverage) with robustness, this study applies different policy preparedness indicators by using data from multi-sources. A cross-sectional analysis was performed. Regression analysis is adopted to examine the relation between four policy preparedness indicators (i.e., [1] International Health Regulations core capacity index, [2] Global Health Security Index, [3] epidemic preparedness index, and [4] World Governance Index) and COVID-19-confirmed cases/death/vaccination coverage at different time points. The linear regression is performed, and the spatial distribution of indicators are illustrated. Countries with higher ranking in policy preparedness indexes can experience less severity of pandemic risk (e.g., confirmed cases and mortality) and faster recovery process (e.g., higher vaccination coverage). However, slight disparity in effectiveness exists across different indicators. Results show that the policy preparedness indicators have predictive value of the confirmed cases, mortality, and vaccination coverage of COVID-19 pandemic, given sufficiently long-time span is observed. [ABSTRACT FROM AUTHOR]

Stadiums are an important part of the entertainment and sporting cultures of communities around the world, but the combination of outdated infrastructure with poor safety planning, large numbers of people gathering within a confined space, and the high frequency of such events have led to a number of significant disasters in the past. This is a descriptive analysis of stadium disasters occurring between 1901 and 2021 which may provide useful insight for event safety personnel and disaster medicine specialists to better prevent and mitigate the effects of potential future stadium disasters. Data were collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all stadium-related accidental disasters occurring between January 1, 1901 - and July 30th, 2022. A disaster is defined by Centre for Research on the Epidemiology of Disasters (CRED) in its glossary as 'technological accidents of an industrial nature, or involving industrial buildings'. All categories and definitions are predetermined by the EM-DATS as per their glossary. The 24th May 1964 Estadio Nacional disaster in Lima, Peru, was the worst (in terms of deaths) to date with 350 deaths. This is followed by the 1982 Luzhniki Stadium disaster in Moscow, Russia (340 deaths), the 2001 Accra Sport Stadium disaster in Ghana (123 deaths), and the 1985 Hillsborough Stadium disaster in Sheffield, England (96 deaths). Fourteen of the 40 stadium disasters occurred in Africa, 11 in Europe, 10 in the Americas, and five in Asia. A total of 40 stadium disasters were included, leading to 2025 deaths and 6640 injuries. This equated to an average of 50.6 deaths and 166.0 injuries per disaster. Given the potential risk of mass casualty events, stadiums should incorporate disaster medicine education, training, and expertise in their emergency medical plans. [ABSTRACT FROM AUTHOR]

This national survey aimed to explore how existing pandemic preparedness plans (PPP) accounted for the demands placed on infection prevention and control (IPC) services in acute and community settings in England during the first wave of the COVID-19 pandemic. This was a cross-sectional survey of IPC leaders working within National Health Service Trusts or clinical commissioning groups/integrated care systems in England. The survey questions related to organisational COVID-19 preparedness pre-pandemic and the response provided during the first wave of the pandemic (January to July 2020). The survey ran from September to November 2021, and participation was voluntary. In total, 50 organisations responded. Seventy-one percent (n = 34/48) reported having a current PPP in December 2019, with 81% (n = 21/26) indicating their plan was updated within the previous 3 years. Around half of IPC teams were involved in previous testing of these plans via internal and multi-agency tabletop exercises. Successful aspects of pandemic planning were identified as command structures, clear channels of communication, COVID-19 testing, and patient pathways. Key deficiencies were lack of personal protective equipment, difficulties with fit testing, keeping up to date with guidance, and insufficient staffing. Pandemic plans need to consider the capability and capacity of IPC services to ensure they can contribute their critical knowledge and expertise to the pandemic response. This survey provides a detailed evaluation of how IPC services were impacted during the first wave of the pandemic and identifies key areas, which need to be included in future PPP to better manage the impact on IPC services. [ABSTRACT FROM AUTHOR]

This study aims to explore the association of hospital infection prevention and control (IPC) structure (i.e. a dedicated IPC team and/or IPC committee) and IPC capacity in Korean hospitals, as well as its implications in the response and preparedness to COVID-19. This was a cross-sectional study using data collected through a nationwide survey. Participating hospitals completed an online questionnaire. Participation was voluntary. The survey questionnaire was developed by the government in consultation with IPC experts. The questionnaire was distributed to 2108 hospitals, including both acute and long-term care hospitals. The independent variables were the presence of an IPC team and/or IPC committee. The dependent variables were IPC activities and capacity measures, which were based on the World Health Organisation (WHO) recommendations on the core components in IPC. A total of 1442 hospitals completed the survey. Hospitals with IPC structures conducted significantly more IPC activities in all outcome measures compared with hospitals without IPC structures, with the exceptions of monitoring hand hygiene and screening for infectious diseases that showed non-significant differences. Hospitals with IPC structures showed a significant difference in performance in IPC risk assessment, operating outbreak response teams and appraisal of hospital IPC policies compared with hospitals without IPC structures. The presence of a dedicated IPC team and IPC committee was associated with increased IPC activities and IPC capacity. Hospitals with IPC teams and IPC committees showed strong implementation of planning, appraisal, resource management and outbreak response, indicating that strengthening IPC structures within hospitals is the key to more effective IPC and disaster response. [ABSTRACT FROM AUTHOR]

The objective of this study is to assess the determinants of willingness to pay to enhance pandemic preparedness in Mauritius. A contingent valuation method is used to estimate willingness to pay to pay for enhancing pandemic preparedness using a sample of working people in Mauritius. A two-phase decision process analysis is carried out to model the willingness to pay to enhance pandemic preparedness. The first phase is to analyse the respondents' decision of whether or not to pay for enhancing pandemic preparedness using a Probit model. The second phase is to estimate the determinants of the amount of money respondents are willing to pay using a Tobit model. Income earners are willing to pay an average of Rs. 1,900 (approximately USD 50) per annum to enhance pandemic preparedness. 'Perceived Response Efficacy', 'Awareness of the Need and Responsibility for Paying', 'Subjective Obligation to Pay' and the 'Theory of Planned Behaviour' are found to affect both stages of of the decision-making process. Knowledge on COVID-19 is found to have a positive impact on the decision to pay and health responsibility attitude is found to have a negative impact on the amount people are willing to pay. On average, the government can potentially expect to mobilise an additional Rs. 1,047,470,000 (USD 27,565,000) from taxpayers to spend on enhancing pandemic preparedness in Mauritius. To increase willingness to pay for enhanced pandemic preparedness, the government can focus on improving knowledge on a pandemic, perceived response efficacy and awareness on need and responsibility of paying. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the concept of flexible surge capacity to reduce the burden on hospitals by focussing on community resources to develop home isolation centres in Bangkok, Thailand. A qualitative study consisted of observational and semi-structured interview data. The development and activities of home isolation centres were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analysed and categorised based on the practical elements necessary in disaster and emergency management. Data were categorised into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: (1) coordination and collaboration; (2) staff engagement; (3) responsibility clarification; and (4) sustainability. Safety presented two subcategories: (1) patients' information privacy and treatment; and (2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organisation (WHO) guidelines and hospital operations. Several supply- and patient-related challenges were identified and managed during centre development. The use of community resources, based on the flexible surge capacity concept, is feasible under restricted circumstances and reduced the burden on hospitals during the COVID-19 pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of emergencies' aetiology. [ABSTRACT FROM AUTHOR]

This study aimed to discuss the overlap between property-level flood adaptation and public health and flood risk management and identify areas of future research. A short essay-based contribution arguing in favour of a future research direction from the perspective of a disaster risk researcher. Promoting property-level flood adaption has multiple areas of benefit to both flooding and mental health risk management as a potential invention. This is because both fields display common interests in enabling and promoting personal responsibility to limit disaster consequences and build resilience. The promotion and development of property-level flood adaptation strategies can be a productive locus of behaviour for further active collaboration and research, as well as a joint intervention for improving human welfare postdisaster. However, more proactive research is required. [ABSTRACT FROM AUTHOR]

This study aims to provide insights into how local resilience structures in England can be leveraged to deliver a whole-of-society approach to managing a national response to extreme heat events during summer months. A communication based on the literature review of currently available research on health emergency response and extreme heat events in England. This communication draws insights from the authors' research programmes, which examined national-level public health emergency response during the COVID-19 pandemic and literature review of the latest available English research on health and extreme heat events. Periods of extreme heat are on the rise in England. Local resilience forums (LRFs), due to their multiagency nature, offer a shared situational awareness and understanding of the need in their local communities. Such information is critical to ensure messaging about heat risks and available resources are tailored to reach specific targeted groups within their communities. Scenario planning and adaptation efforts require a more local articulation which LRFs are well placed to manage. LRFs are well suited as key structures in the English emergency response to extreme heat events. We suggest that English public health and hospital organisations, working with community partners via the LRFs, must develop their thinking about pressures from adverse weather in the summer months. [ABSTRACT FROM AUTHOR]

Factors associated with an individual's awareness of vulnerability can be modified by the infrastructure of a city. These factors may impact disaster preparedness among local populations in an infrastructure-resilient city, which further influences the health risks of various population subgroups. This was a population-based study. Four population subgroups, which have previously been reported to be related to awareness of vulnerability (i.e. past experiences, sociodemographic deprivation, poor housing conditions and family medical needs), were analysed for their impacts on disaster preparedness. Validated population-based phone interviews (n = 856) were conducted in Hong Kong. Three types of disaster preparedness were studied: (1) physical preparedness; (2) social preparedness; and (3) education preparedness. Previous experience of social hazards, accidental hazards and epidemics increased disaster preparedness among the local population. Specifically, experiences of accidental hazards and social hazards were positively associated with physical preparedness (odds ratios 1.626, 95% confidence interval [95% CI] 1.215, 2.172) and 1.501 [95% CI 1.114, 2.024], respectively). However, experiences of natural hazards did not increase preparedness, even in Hong Kong, which is a city with high 'disaster resilience' because of its well-developed infrastructure. Moreover, individuals with a low educational level or low income had lower education preparedness, unmarried individuals had lower social preparedness, and poor housing conditions of non-private-housing households had negative associations with education preparedness. These findings partially align with local disaster responses to the 2018 Typhoon Mangkhut, the 2019 social unrest and the 2020 COVID-19 pandemic, all of which were observed after the 2018 survey reported in this study. Social and environmental interventions should be targeted to marginalised subpopulations through location-based community strategies to encourage increased environmental knowledge and participation in disaster preparedness activities. [ABSTRACT FROM AUTHOR]

This study aims to develop a theoretical framework for the flexible surge capacity, inspired by existing surge capacity, complexity theory, and collaborative theoretical frameworks, and discuss its implementation and use in emergencies. This was a descriptive study. Theoretical frameworks for surge capacity, the complexity and resilience theory, and collaboration were reviewed and combined to develop a theoretical framework for the flexible surge capacity, incorporated with standard practical tools used in disaster and emergency management as interconnecting collaborative factors. The expanded number of disasters, public health emergencies, and the emergence of new risks and vulnerabilities indicate a complex situation and an apparent need to revisit the core of preparedness for unexpected incidents. Four crucial elements as parts of surge capacity, that is, staff, stuff, space, and systems, need to be considered in the planning and managing disasters and emergencies. Within the ordinary contingency plans, primary and secondary surges are planned and prepared. However, there are situations where those surges may not exist or are impossible to deliver. In such situations, available community resources should be used, described as flexible surge capacity. The flexible surge capacity framework incorporates a balanced and innovative process of integrating various resilience factors in complex incidents and collaboration among multiagency organizations. The flexible surge capacity theoretical framework was developed. Nonetheless, further studies on the willingness of the medical and non-medical organizations to partake in the flexible surge capacity system are required. [ABSTRACT FROM AUTHOR]

Healthcare professionals' high risk of infection and burnout in the first months of the COVID-19 pandemic probably hindered their much-needed preparedness to respond. We aimed to inform how individual and institutional factors contributed for the preparedness to respond during the first months of a public health emergency. Cross-sectional study. We surveyed healthcare workers from a Local Health Unit in Portugal, which comprises primary health care centers and hospital services, including public health units and intensive care units, in the second and third months of the COVID-19 epidemic in Portugal. The 460 answers, completed by 252 participants (about 10% of the healthcare workers), were analyzed using descriptive statistics and multiple logistic regressions. We estimated adjusted odds ratios for the readiness and willingness to respond. Readiness to respond was associated with the perception of adequate infrastructures (aOR = 4.04, P < 0.005), lack of access to personal protective equipment (aOR = 0.26, P < 0.05) and organization (aOR = 0.31, P < 0.05). The willingness to act was associated with the perception of not being able to make a difference (aOR = 0.05, P < 0.005), risk of work-related burnout (aOR = 21.21, P < 0.01) and experiencing colleagues or patients' deaths due to COVID-19 (aOR = 0.24, P < 0.05). Adequate organization, infrastructures, and access to personal protective equipment may be crucial for workers' preparedness in a new public health emergency, as well workers' understanding of their roles and expected impact. These factors, together with the risk of work-related burnout, shall be taken into account in the planning of the response of healthcare institutions in future public health emergencies. [ABSTRACT FROM AUTHOR]

Many African countries have reported fewer COVID-19 cases than countries elsewhere. By the end of 2020, Guinea-Bissau, West Africa, had <2500 PCR-confirmed cases corresponding to 0.1% of the ∼1.8 million national population. We assessed the prevalence of SARS-CoV-2 antibodies in urban Guinea-Bissau to help guide the pandemic response in Guinea-Bissau. Cross-sectional assessment of SARS-CoV-2 antibody in a cohort of staff at the Bandim Health Project. We measured IgG antibodies using point-of-care rapid tests among 140 staff and associates at a biometric research field station in Bissau, the capital of Guinea-Bissau, during November 2020. Of 140 participants, 25 (18%) were IgG-positive. Among IgG-positives, 12 (48%) reported an episode of illness since the onset of the pandemic. Twenty-five (18%) participants had been PCR-tested between May and September; 7 (28%) had been PCR-positive. Four of these seven tested IgG-negative in the present study. Five participants reported that somebody had died in their house, corresponding crudely to an annual death rate of 4.5/1000 people; no death was attributed to COVID-19. Outdoor workers had a lower prevalence of IgG-positivity. In spite of the low official number of COVID-19 cases, our serosurvey found a high prevalence of IgG-positivity. Most IgG-positives had not been ill. The official number of PCR-confirmed COVID-19 cases has thus grossly underestimated the prevalence of COVID-19 during the pandemic. The observed overall mortality rate in households of Bandim Health Project employees was not higher than the official Guinean mortality rate of 9.6/1000 people. [ABSTRACT FROM AUTHOR]

The management of non-communicable chronic diseases such as diabetes mellitus is often poor in humanitarian crisis settings. Poor disease management can have serious long-term consequences. This review sought to identify studies that explored the effectiveness of interventions and the determinants that may improve the management of diabetes in the humanitarian context. A systematic review was conducted of all types of studies that implemented diabetes programmes in humanitarian settings. MEDLINE, Embase, CINAHL and Web of Science were searched for relevant articles using multiple search terms for relevant studies published in English between 2000 and June 2020. Quality assessments using valid tools, were conducted. A narrative synthesis of the findings was then performed. The search yielded 550 citations. After de-duplicating and screening, 19 studies were eligible for inclusion. Most studies were conducted in the Middle East (74%), Asia (16%) and Africa (10%). The interventions reported to improved diabetes care included the mHealth tool, intensive lifestyle intervention, task-shifting, psychosocial support, distribution of glucometers and comprehensive care. Insufficient drug supply, out-of-pocket cost, the complexity of insulin therapy and low adherence to guidelines were identified as barriers. There is a paucity of evidence on optimal diabetes care in acute crisis and natural disaster settings. The review was constrained by the low quality of the studies included. Nevertheless, it is likely that mHealth can be feasibly utilised, as educational SMS messages are cost-effective and electronic medical records can enhance disease monitoring. In addition, a multidisciplinary approach to care improves glycaemic control and is desirable due to the multifaceted nature of the disease and management required. Several key barriers have been identified that need to be tackled. Overall, the evidence base for diabetes care in humanitarian settings remains sparse, and further research is needed. [ABSTRACT FROM AUTHOR]

This article evaluates the application of 'incident control' methodology usually applied in communicable disease control to an 'incident' of unexplained deaths, specifically to resolve a significant difference in 1-year survival after a lung cancer diagnosis observed between two Clinical Commissioning Groups and the England national average, 2011–14. The purpose of the evaluation was to assess whether a formalised incident control approach is feasible and effective in improving outcomes for non-communicable diseases. Descriptive, qualitative, process evaluation. There were two components to the evaluation: a document review against identified phases of a non-communicable disease incident control framework and a qualitative analysis of semi-structured interviews with stakeholders who had been involved in implementation. The findings indicate feasibility of the incident control model, with some limitations. Identified strengths of the model included the articulation of a clear case and incident definition. The structure and stepped phased approach facilitated partner engagement, robust data analysis, action planning and communication strategies. Delays in data publication and the lack of comparable data across different non-communicable diseases present challenges in timely response and prioritisation of 'incidents'. The evaluation indicates value in applying defined incident control methodology to management of non-communicable diseases, especially where there is identification of a potential outlier or a measurable variation, i.e. there is a definable 'incident' and 'case'. [ABSTRACT FROM AUTHOR]

The catastrophic effects of armed conflict, particularly prolonged armed conflict, on individual and public health are well established. The 'right' to healthcare during armed conflict and its lack of enforcement despite a range of United Nations mandated requirements regarding health and healthcare provisions is likely to be a significant feature in future conflicts, as zoonotic-induced pandemics become a more common global public health challenge. The issue of enforcement of health rights assurance and its implications for the public health management of global pandemics such as coronavirus disease 2019 (COVID-19) in and between countries and regions in conflict is the objective of this Review. A narrative review was conducted. Referenced to the framework of International humanitarian law (IHL) and International human rights law (IHRL) to explore and discuss the deficits in health rights assurances in conflict settings and illustrate how gaps in protection and lack of enforcement compounds the disease response. Both IHL, and IHRL can be leveraged to ensure human and health rights are assured in conflict settings. There is a distinct lack of international criteria with regard to standards of healthcare coverage, infrastructure and service preservation to the civilian population during times of armed conflict. This has far reaching consequences when confounded by a pandemic or even localised disease outbreak. We illustrate how in a pandemic disease emergency, such as COVID-19, all life is threatened; and how leaving the citizen population exposed to this contagion is a human rights breach and an indirect method of warfare. The consequences of failure to effectively address such pandemic infections, (i.e. COVID-19), in a conflict setting are potentially catastrophic as prevention and containment responses are severely constrained by state insecurity, political instability, terrorism, repression, rights abuses, and displacement of citizens. Neglect by State actors potentially constitutes a breach of the universal right to life. States cannot justify their failures to mitigate disease based on claims of lack of resources, even when available resources are minimal. Where discrimination of people with a disease, such as COVID-19, or minority groups at the point of access to health facilities occurs, this further breaches the principle of medical neutrality. The example of the COVID-19 response may offer a viable route to leverage greater access and coverage of healthcare in conflict and humanitarian settings. A radicalised partnership approach during these times of emergency is warranted, based on an ethical ' humanitarian intervention' approach to provide care to all affected by contagious disease in conflict settings. • The catastrophic effects of armed conflict on individual and public health are well established with zoonotic induced pandemics a challenge. • International humanitarian and human rights law can be leveraged to ensure health rights are assured in conflict settings. • In a pandemic disease leaving citizens exposed to contagion is a human rights breach and an indirect method of warfare. • States cannot justify their failures to mitigate disease based on claims of lack of resources. • COVID-19 responses may offer a viable route to leverage greater access and coverage of healthcare in conflict settings. [ABSTRACT FROM AUTHOR]

The objective of this study is to understand how Cuba responds to extreme weather events, which can help identify and disseminate good public health practice. The study design of this study is an observational study using routinely collected mortality data. National daily mortality counts after severe hurricanes arrived on the Cuba landmass since 1990 were compared with baseline values. Incidence rate ratios of mortality during the hurricane and for the four weeks afterwards were calculated for four eligible hurricanes: Georges (1998), Dennis (2005), Ike (2008) and Irma (2017). Mortality rates decreased over time (P < 0.001 for interaction), and no excess mortality counts were observed after Hurricane Irma in 2017. Mortality rates for severe hurricanes that have made landfall in Cuba have decreased over three decades, despite the most recent hurricane (Irma) being one of the strongest observed in recent decades. This suggests that the Cuban public health preparations and responses to recent severe hurricanes are probably contributing to this mitigation in national mortality rates during these periods. • National mortality rates from severe hurricanes in Cuba have decreased over the past three decades. • No excess mortality counts were observed after the most recent severe hurricane (Hurricane Irma) in 2017, despite the fact that it was one of the strongest hurricanes observed in recent decades. • Cuban public health preparations and responses to recent severe hurricanes may mitigate national mortality. [ABSTRACT FROM AUTHOR]

The aim of this study was to develop and implement a lay responder disaster training (LRDT) package with the intention to alter the perceived efficacy, perceived threat, and levels of fear among school teachers. The study used an intervention-based design, wherein we intervened by conducting an LRDT which aimed to affect the participants' responses as defined by Witte's behavioral model (WBM). The LRDT package incorporated the usual disaster preparedness information but included the unexplored area of disaster first aid, which is lacking in most training currently being given. The entire LRDT was carried out for two consecutive days by an emergency medical services–accredited competency assessor. Preintervention and postintervention knowledge, level of fear, attitude, intentions, behavior, and a Risk Behavior Diagnosis Scale was assessed using a structured questionnaire based on the WBM. After conducting the LRDT as an intervention, the results show that there was a significant change in the knowledge, behavior, perceived threat, and level of fear among the participants. Other constructs, such as attitude, intentions, and perceived efficacy, were not statistically significant after the intervention. In conclusion, knowledge, behavior, and the perceived threat of the school teachers were significantly higher after the LRDT, and their level of fear was significantly lower. Based on these results, we can conclude that both the WBM questionnaire and the LRDT package showed potential in improving disaster risk reduction and management among school teachers in Angeles City, Philippines. • The study developed and implemented a lay responder disaster training (LRDT) package among Filipino school teachers. • A questionnaire based on the Witte's behavioral model (WBM) was designed to evaluate the LRDT. • Significant change in the WBM constructs was observed after the LRDT. • Improvement in the knowledge has an effect on some WBM constructs. [ABSTRACT FROM AUTHOR]

This article describes the rapid mitigation strategies in addressing the rising number of coronavirus disease 2019 (COVID-19) cases in Singapore. Learning from the severe acute respiratory syndrome experience in 2003, early preparation started in January 2020 when Wuhan was declared as the epicentre of the epidemic. The government had constructed a three-pronged approach which includes travel, healthcare and community measures to curb the spread of COVID-19. • This article describes the preparations and rapid mitigation strategies in addressing the rocketing number of coronavirus disease 2019 (COVID-19) cases in Singapore. • The government had constructed a three-pronged approach which includes travel, healthcare and community measures to curb the spread of COVID-19. • Careful and thoughtful planning with successive rapid executions were necessary to balance the profound impact of the socio-economic activities and the healthcare system. [ABSTRACT FROM AUTHOR]

The Canadian government decision to cancel the mandatory long-form census in 2010 (subsequently restored in 2015), along with similar discussions in the United Kingdom (UK) and the United States of America (USA), have brought the purpose and use of census data into focus for epidemiologists and public health professionals. Policy decision-makers should be well-versed in the public health importance of accurate and reliable census data for emergency preparedness planning, controlling disease outbreaks, and for addressing health concerns among vulnerable populations including the elderly, low-income, racial/ethnic minorities, and special residential groups (e.g., nursing homes). Valid census information is critical to ensure that policy makers and public health practitioners have the evidence needed to: (1) establish incidence rates, mortality rates, and prevalence for the full characterization of emerging health issues; (2) address disparities in health care, prevention strategies and health outcomes among vulnerable populations; and (3) plan and effectively respond in times of disaster and emergency. At a time when budget and sample size cuts have been implemented in the UK, a voluntary census is being debated in the US. In Canada, elimination of the mandatory long-form census in 2011 resulted in unreliable population enumeration, as well as a substantial waste of money and resources for taxpayers, businesses and communities. The purpose of this article is to provide a brief overview of recent international trends and to review the foundational role of the census in public health management and planning using historical and current examples of environmental contamination, cancer clusters and emerging infections. Citing a general absence of public health applications of the census in cost-benefit analyses, we call on policy makers to consider its application to emergency preparedness, outbreak response, and chronic disease prevention efforts. At the same time, we call on public health professionals to improve published estimates of monetary benefit (via either cost-benefit or cost-effectiveness analysis) to a given public health intervention. [ABSTRACT FROM AUTHOR]

Objectives: To propose a simple and effective tool for decision-making regarding general evacuation during a rapid river flood. Study design: Virtual testing of a tool in a real event. Method: A four-component tool was applied to build an alternative scenario of the catastrophic river flood in Obrenovac, Serbia, on May 2014. The components of this tool are: (1) the amount of precipitation above the 95th percentile of all previous measurements; (2) upstream river discharge above the 95th percentile of all previous measurements; (3) upstream river level above the 95th percentile of all previous measurements; and (4) worsening of the hydrometeorological situation in the following 48 h. Results: In the early morning of 16 May 2014, a rapid river wave flooded 80% of the Obrenovac territory. There were 13 deaths due to drowning. Application of the study tool shows that these lives could have been saved, as the score to recommend general evacuation was reached 1 day before the flooding. The application of this tool to two previous great floods in Serbia shows that the score to recommend general evacuation was reached either 1 day before or on the onset of flash flooding. Conclusions: Due to its simplicity, this tool is universally applicable to facilitate decisionmaking regarding general evacuation during a rapid river flood, and it should be further tested in future similar catastrophes. [ABSTRACT FROM AUTHOR]

The article focuses on a study regarding implementation of disaster management plan of Universidad San Francisco de Quito, Ecuador's Medical School, which includes mental health aid, setting up of base camps, and multidisciplinary teams.

Objectives: The 2014-15 Ebola outbreak in West Africa highlighted the challenges many hospitals face when preparing for the potential emergence of highly contagious diseases. This study examined the experiences of frontline health care professionals in an Australian hospital during the outbreak, with a focus on participant views on information, training and preparedness, to inform future outbreak preparedness planning. Study design: Semi-structured interviews were conducted with 21 healthcare professionals involved in Ebola preparedness planning, at a hospital in Australia. Methods: The data were systematically coded to discover key themes in participants' accounts of Ebola preparedness. Results: Three key themes identified were: 1) the impact of high volumes of--often inconsistent--information, which shaped participants' trust in authority; 2) barriers to engagement in training, including the perceived relative risk Ebola presented; and finally, 3) practical and environmental impediments to preparedness. Conclusions: These clinicians' accounts of Ebola preparedness reveal a range of important factors which may influence the relative success of outbreak preparedness and provide guidance for future responses. In particular, they illustrate the critical importance of clear communication and guidelines for staff engagement with, and implementation of training. An important outcome of this study was how individual assessments of risk and trust are produced via, and overlap with, the dynamics of communication, training and environmental logistics. Consideration of the dynamic ways in which these issues intersect is crucial for fostering an environment that is suitable for managing an infectious threat such as Ebola. [ABSTRACT FROM AUTHOR]

Objectives: Globally, the incidence of natural disasters is increasing with developing countries tending to be worst affected. Implementing best practices in disaster management that are evidence-based is essential in order to improve disaster resilience and response. This study explores the barriers to evidence-based disaster management encountered in Nepal. Study design: A qualitative study was conducted in Nepal involving interviews with key informants in the disaster management field. Methods: Government officials, academics, programme managers, disaster management practitioners and policymakers involved in disaster management were purposively sampled and invited to interview. 11 agreed to participate and were interviewed. The face-to-face interviews were recorded, transcribed and analysed using thematic analysis. Results: The interviews uncovered population-level barriers such as contextual factors (e.g. poverty), local custom and culture, as well as community-level issues (e.g. level of engagement and understanding). System-level barriers included limited demand for, availability and accessibility of the evidence-base. The implementation of evidence was influenced by the configuration of the disaster management system and system processes. Political ownership and leadership is an essential determinant of practice. Conclusions: Several barriers to evidence-based practice in disaster management exist in Nepal. The relative influence of the different barriers varies with political determinants likely to have greater importance in countries such as Nepal where system governance and leadership is insufficiently developed. These issues affect a country's vulnerability to disasters and need to be addressed. [ABSTRACT FROM AUTHOR]

Objectives: Numerous interventions seeking to increase preparedness for pandemic influenza have been implemented, but low compliance of healthcare providers has been reported in many instances. The aim of this study was to identify factors that affect preparedness for pandemic influenza by examining: hospital managers' perceptions of measures implemented to promote preparedness for pandemic influenza; hospital managers' assessments of the readiness and capability of their hospitals to manage pandemic influenza; and the effectiveness of a national pandemic preparedness programme in Israel overtime. Study design, A quasi-experiment was conducted following implementation of a national pandemic preparedness programme in Israel. A survey assessed hospital managers' perceptions of the effectiveness of the programme, and the preparedness and capacity of their hospitals to manage pandemic influenza. Two independent evaluations of preparedness for biological threats were conducted, based on a validated tool that included 60 objective parameters. Methods: Correlations between perceived preparedness and capacity and components of the preparedness programme were analysed using Statistical Package for the Social Sciences Version 17. Stepwise logistic regression was used to determine the components that influence preparedness and capability to manage pandemic influenza. Results: All general hospital managers in Israel were approached twice (first and second evaluations). Ninety-one percent rated themselves as highly/very highly prepared for pandemic influenza, and 87% rated themselves as highly/very highly capable of dealing with pandemic influenza. Strong correlation was found between hospital managers' perceived preparedness and capacity to manage pandemic influenza (rho = 0.761, P = 0.000), and between perceived preparedness and familiarity with the disease (rho = 0.605, P = 0.003). Familiarity with guidelines accounted for 35% of the variance in perceived capability (adjusted R2 = 0.346, P = 0.002). Inclusion of preparedness evaluations explained an additional 15% of the variance (R2 change = 0.146, P = 0.026). An increase in mean total score for emergency preparedness was found in the second evaluation compared with the first evaluation. Conclusions: Familiarity with guidelines and preparedness evaluations affect the perceptions of healthcare managers regarding preparedness and capability to manage pandemic influenza. [ABSTRACT FROM AUTHOR]

More than 2 years after the start of pandemic H1N1, the world is fortunate that the impact, to date, has been moderate. An evaluation of the global response to the first wave of the pandemic is still ongoing. The results of an analysis of the situation in China is presented in order to gain a better understanding of the episode; to summarize the experiences in preparedness, control and mitigation of the pandemic; and to identify issues for further consideration and investigation in order to improve the response to possible next waves of the pandemic. China's response shows how a huge challenge can be transformed into an opportunity, and may offer some valuable lessons to face another wave of the pandemic or other potential public health emergencies in the future, not only for China but also for the international community. [ABSTRACT FROM AUTHOR]

Objectives: Since the outbreaks of severe acute respiratory syndrome and avian influenza, improving the emergency preparedness capability of rural public health personnel has become a new priority in building the infrastructure needed to address public health emergencies. The Chinese Government has carried out a series of emergency preparedness education and training programmes to improve the emergency preparedness capability of rural public health personnel nationwide. The purpose of this study was to evaluate and develop a participatory emergency preparedness training programme for rural public health personnel. Study design: The research emphasizes the major components of instructional design, including assessing, designing, delivering and evaluating training. The approach is an integrated system with results from one phase influencing the next, so that a series of steps are followed when developing, implementing and evaluating emergency preparedness training. Methods: The 226 participants were rural public health personnel from 84 different rural centres for disease control and prevention in China. The programme was evaluated by anonymous questionnaires and semi-structured interviews held prior to training, immediately post-training and 12- months after training (follow-up). Results: The emergency preparedness training resulted in positive shifts in knowledge and skills for rural public health personnel. At follow-up, the knowledge and skill scores of participants declined slightly compared with the post-test levels (P > 0.05). However, there was a significant increase compared with the pre-test levels (P < 0.01). Moreover, more than 90% of participants reported that this training provided a valuable learning experience and reinforced the importance of emergency preparedness. Conclusions: The emergency preparedness training programme was effective and feasible in improving the performance of rural public health personnel on emergency response. Further studies are needed to test the efficacy of the training approach for competency improvement. [ABSTRACT FROM AUTHOR]

Objectives: Mr Alexander Litvinenko died in a London hospital on 23 November 2006, allegedly from poisoning with the radionuclide polonium-210 (210Po). Associated circumstances required an integrated response to investigate the potential risk of internal contamination for individuals exposed to contaminated environments. Study design: Descriptive study. Methods: Contaminated locations presenting a potential risk to health were identified through environmental assessment by radiation protection specialists. Individuals connected with these locations were identified and assessed for internal contamination with 210Po. Results: In total, 1029 UK residents were identified, associated with the 11 most contaminated locations. Of these, 974 were personally interviewed and 787 were offered urine tests for 210Po excretion. Overall, 139 individuals (18%) showed evidence of probable internal contamination with 210Po arising from the incident, but only 53 (7%) had assessed radiation doses of 1 mSv or more. The highest assessed radiation dose was approximately 100 mSv. Conclusions: Although internal contamination with 210Po was relatively frequent and was most extensive among individuals associated with locations judged a priori to pose the greatest risk, a high degree of assurance could be given to UK and international communities that the level of health risk from exposure to the radionuclide in this incident was low. [ABSTRACT FROM AUTHOR]

The article presents a paper that studies climate change adaptation in public health system in Great Britain. Topics discussed the National Adaptation Plan (NAP) to climate change published in Great Britain in 2013, gap observed between national research and policy and local needs, and advocates implementation of climate change adaptation.

Objective: To examine the impact of humanitarian aid from the perspectives of local stakeholders in Sri Lanka following the tsunami disaster of December 2004. Study design: Qualitative study using key informant and focus group interviews. Methods: Key informant and focus group interviews were conducted with tsunami survivors, community leaders, the local authorities and aid workers sampled purposively. Collected data were analysed using thematic analysis. Results: Aid aggravated social tensions and the lack of community engagement led to grievances. There was a perceived lack of transparency, beneficiary expectations were not always met, and it was difficult to match aid to needs. Rapid participatory approaches to obtain beneficiary feedback in post-disaster settings are possible but have limitations due to respondent bias. Conclusions: In order to mitigate adverse social impacts of their programmes, humanitarian aid agencies need to better understand the context in which aid is delivered. Beneficiary feedback is essential in disaster planning and response so that disaster response can be better matched to the needs of beneficiaries. [ABSTRACT FROM AUTHOR]

Objectives: To present crucial stages of planning and the resources involved in the medical and health care that will address issues affecting the health ,and safety of all participants in the 2010 World Cup. Design: Relevant literature reviews of mass gathering medical care supplemented experience of the authors in planning for previous similar events. Attention is focused on issues wherein effective planning requires the integration of public health practices with those of clinical emergency medical services. The tames that are included serve to illustrate the depth and breadth of planning as well as the organizational relationships required to execute care of a universally acceptable standard. Conclusions: This article offers guidance in planning for the 2010 World Cup health ;and emergency medical care, emphasizing the need for integration of public health and medical practices. It depicts the span of planning envisioned, the organizational relationships crucial to it, and emphasizes the necessity of an early start. [ABSTRACT FROM AUTHOR]

Background: The severe acute respiratory syndrome (SARS) crisis of 2003 provided a new urgency in China in terms of preparing public health staff to respond effectively to public health emergencies. Although the Chinese Government has already carried out a series of emergency education and training programmes to improve public health staff's capability of emergency preparedness, it remains unclear if these training programmes are effective and feasible. The purpose of this research was to evaluate an emergency preparedness training programme and to develop a participatory training approach for emergency response. Methods: Seventy-six public health staff completed the emergency preparedness training programme. The effectiveness of the training was evaluated by questionnaire before training, immediately after training and 12 months after training (follow-up). Additionally, semi-structured interviews were conducted throughout the training period. Results: The emergency preparedness training improved the knowledge levels and increased attitudinal and behavioural intention scores for emergency preparedness (P<0.01). The results at follow-up showed that the knowledge levels and attitudinal/behavioural intention scores of participants decreased slightly (P>0.05) compared with levels immediately after training (P<0.01). However, there was a significant increase compared with before training (P<0.01). Moreover, more than 80% of participants reported that the training process and resources were scientific and feasible. [ABSTRACT FROM AUTHOR]

Objectives: We examined the manner in which state public health agencies have organized their operations to accomplish the goats associated with emergency preparedness (EP) funds. We also examined the leadership challenges associated with the effective utilization of preparedness funds. Methods: The websites of all 50 state public health organizations in the USA were examined in order to determine the different approaches that states have used to organize for preparedness. Thirty-eight states provided sufficient information to allow for classification of their organizational approach to EP. Telephone interviews were conducted with representatives in three model states to obtain deeper insights into the organizational approach. Results: Three predominant organizational models were identified as a means to address the challenge of organizing for preparedness. The results confirmed the equifinality principle of organization (there may be more than one equally effective way to organize) and demonstrated that, contrary to the prescription of early management thought, there is no 'one best way' to organize. Leadership rather than formal management emerged as the primary contributor to perceived EP. Specifically, interviews with preparedness professionals indicated that they believed expert power was more important than position power and the ability to negotiate and influence through persuasion was more important than format authority. Conclusions: All three models contained, to a greater or lesser degree, elements of matrix management with the associated leadership challenges for emergency preparedness (EP) directors. Recommendations were provided for successful leadership in the context of EP directors in state departments of public health. [ABSTRACT FROM AUTHOR]

Objectives: Following the events of 11 September 2001 in New York, planning for the deliberate release of chemical, biological, radiological and nuclear agents has intensified in the UK, with Department of Health recommendations for National Health Service and public health action. A consequence of this was to assess preparedness across the West Midlands region of England for mounting an effective response to a deliberate release of a biological agent. Study design: Descriptive study. Setting: West Midlands, UK. This work involved key organizations and entailed obtaining information from those responsible for and likely to be involved in managing incidents via questionnaire surveys based around preparedness and planning arrangements. Results: Findings revealed that plans delineating action to take during an incident do exist. However, staff training (40%) in acute trusts and testing of plans in primary care trusts (45%) could be improved. Communication arrangements in hospitals require support. Conclusion: Work is ongoing but there is more to do. Trusts should provide staff training and engage in exercises to test plans and communication arrangements. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including cold weather planning, the English Cold Weather Plan, and the importance of a syndromic surveillance system to capture cold weather events.

The author reflects on the way public health professionals predict the future of public health. Author H. G. Wells used the opportunities presented by possible futures to explore the impact of social development and scientific discoveries on humanity. Speculating about the future helps maintain emergency preparedness. Public health futurologists should make realistic speculations and must avoid being overly pessimistic in their views.