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Background: Every year, people in Canada are evacuated due to wildland fires to avoid death, injury, and illness from fire and smoke events. Aims: In this paper, we provide an overview of evacuations recorded in the Canadian Wildland Fire Evacuation Database between 1980 and 2021. Methods: Our analysis covers evacuations in Canada from 1980 to 2021. We provide summary statistics including number of evacuations and evacuees, evacuation duration, seasonality, evacuation causes, community types, structure losses, and fatalities. We also investigate temporal and spatial patterns. Key results: Between 1980 and 2021, there were 1393 wildland fire evacuation events with 576,747 people evacuated. During this period, there was an overall increase in frequency of evacuations, number of evacuees, and duration of events. Structure loss occurred during 194 evacuation events, with 4105 homes burned. We estimate wildland fire evacuations cost at least CAD3.7 billion (excluding structural losses), jumping to CAD4.6 billion if we include productivity losses. Indigenous peoples are disproportionately impacted in wildfire evacuations compared to the general Canadian population. Conclusions: Wildland fire evacuations continue to occur across Canada and are increasing. Implications: The findings from this study give us a better understanding of the characteristics of wildland fire evacuations, which can help guide emergency management. This paper summarises data on wildland fire evacuations in Canada between 1980 and 2021. There were 1393 wildland fire evacuation events with 576,747 people evacuated, costing approximately CAD4.6 billion CDN including productivity losses. [ABSTRACT FROM AUTHOR]

Purpose: COVID-19 impact on the population's mental health has been reported worldwide. Predicting healthcare workers' mental health and life stress is needed to proactively plan for future emergencies. Design: Statistics Canada has surveyed Canadian healthcare workers and those working in healthcare settings to gauge their perceived mental health and perceived life stress. Setting: A cross-sectional survey of healthcare workers in Canada. Subjects: A sample of 18,139 healthcare workers respondents. Analysis: Eight algorithms, including Logistic Regression, Random Forest (RF), Naive Bayes (NB), K Nearest Neighbours (KNN), Adaptive boost (AdaBoost), Multi-layer perceptron (MLP), XGBoost, and LightBoost. AUC scores, accuracy and precision were measured for all models. Results: XGBoost provided the highest performing model AUC score (AUC = 82.07%) for predicting perceived mental health, and Random Forest performed the best for predicting perceived life stress (AUC = 77.74%). Perceived health, age group of participants, and perceived mental health compared to before the pandemic were found to be the most important 3 features to predict perceived mental health and perceived stress. Perceived mental health compared to before the pandemic was the most important predictor for perceived life stress. Conclusion: Our models are highly predictive of healthcare workers' perceived mental health and life stress. Implementing scalable, non-expensive virtual mental health solutions to address mental health challenges in the workplace could mitigate the impact of workplace conditions on healthcare workers' mental health. [ABSTRACT FROM AUTHOR]

Background: Since the start of the COVID-19 pandemic in Canada, the cannabis industry has adapted to public health emergency orders which had direct and indirect consequences on cannabis consumption. The objective of this scoping review was to describe the patterns of consumption and cannabis-related health and safety considerations during the COVID-19 pandemic in Canada. Methods: For this scoping review, we searched four electronic databases supplemented with grey literature. Peer-reviewed or pre-print studies using any study design and grey literature reporting real-world data were included if published in English between March 2020 and September 2021 and focused on cannabis and COVID-19 in Canada. A content analysis was performed. Results: Twenty-one studies met the inclusion/exclusion criteria. Study designs included cross-sectional surveys (n = 17), ecological study (n = 1), conceptual paper (n = 1), longitudinal study (n = 1), and prospective cohort study (n = 1). Most were conducted solely in Canada (n = 18), and the remaining included global data. Our content analysis suggested that cannabis consumption during the pandemic varied by reasons for use, consumers' age, gender, and method of consumption. Health and safety impacts due to the COVID-19 pandemics included increased mental illness, increased emergency visits, and psychosocial impacts. Discussion: This scoping review suggested that the impact of the pandemic on cannabis consumption in Canada is more complex than simplistic assumptions of an increase or decrease in consumption and continues to be difficult to measure. This study has explored some of those complexities in relation to reasons for use, age, gender, method of consumption, and health impacts. This scoping review is limited by focusing on the breadth compared to depth. Conclusions: Legalizing nonmedical use of cannabis in Canada in 2018 has had its challenges of implementation, one of which has been the changing context of the society. The findings of this study can help inform cannabis policy updates in Canada as the country is reaching its fifth year of legalizing nonmedical use of cannabis. [ABSTRACT FROM AUTHOR]

In the spring of 2020, remote Indigenous communities in the far northwestern region of Saskatchewan, Canada, experienced a COVID-19 outbreak that required the collaboration of local leaders, Indigenous governments, and other multi-sectoral organizations. This study shares the stories of those involved in the response and illustrates the challenges, successes, and recommendations for future emergency preparedness. A total of 22 participants were interviewed from the impacted communities, government agencies, and organizations in public health, public safety, and law enforcement between May and August of 2021. Qualitative interviews were analyzed using thematic analysis resulting in the following themes: 1) Challenges, 2) Consequences, 3) Successes, and 4) Recommendations. A final knowledge translation event was held with key stakeholders, including public health professionals and community members, to co-create final recommendations for future public health responses in remote Indigenous communities. Our findings underscored the importance of community leadership, local investment, public health preparedness, and relationship-building between organizations and jurisdictions. Lessons and recommendations from these stories can be applied to future pandemic preparedness in the province. [ABSTRACT FROM AUTHOR]

Background: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. Methods: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. Results: A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. Conclusions: During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic highlighted and exacerbated inequities in health for structurally marginalised Canadians. Their location on society's hierarchies constrained their ability to access healthcare and follow recommended health behaviours. The aim of this article is to identify, from the perspective of marginalised populations, factors influencing the acceptance or rejection of COVID-19 countermeasures by structurally marginalised Canadians. Interviews were conducted with Canadians 18 + who identified as Black (n = 8), First Nations, Métis, or Inuit (n = 7) and low-income (<40,000 annual household income) (n = 8) between August and December 2021. Measures were said to impact well-being and interfere with revenue generating activities. Longstanding unfavourable living and environmental conditions as they relate to structural marginalisation was said to fuel anger toward the government and lead to a greater reluctance to accept countermeasures. Participants described concerns about government decisions being made without considering their unique contexts, or knowledge of the experiences of the population for whom these decisions were being made. Effective proactive action from government is important to foster trust with marginalised populations to support acceptance of health information and address growing inequities. Action that demonstrates government competence and commitment to the interests of marginalised populations is critical. [ABSTRACT FROM AUTHOR]

Background: Following the SARS pandemic, jurisdictions around the world began developing ethical resource allocation frameworks for future pandemics-one such framework was developed by Thompson and colleagues. While this framework offers a solid backbone upon which decision-makers can rest assured that their work is driven by rigorous ethical processes and principles, it fails to take into account the nuanced experiences and interests of children and youth (i.e., young people) in a pandemic context. The current COVID-19 pandemic offers an opportunity to re-examine this framework from young people's perspectives, informed by advances in childhood ethics and children's rights.Main Body: In this paper, we revisit the Thompson et al. framework and propose adaptations to the ethical processes and values outlined therein. This work is informed by expertise in clinical ethics and literature related to impacts of COVID-19 and other pandemics on the health and well-being of children around the world, though with particular attention to Canada. During the processes of drafting this work, stakeholders were consulted-aligned with the approach used by Thompson and colleagues-to validate the interpretations provided. We also propose a new principle, namely practicability, to indicate the complex balance between what is possible and what is convenient that is required in ethically sound decisions in the context of services affecting young people. We outline and discuss the strengths and limitations of our work and indicate next steps for scholars in the areas of childhood studies and child health.Conclusion: Efforts to ensure frameworks are truly child-inclusive should be the status-quo, so pandemic impacts and policy implications can be considered in advance of emergency preparedness contexts. [ABSTRACT FROM AUTHOR]

COVID-19 prompted an abundance of independent and collaborative quick response disaster research (QRDR) initiatives globally. The 2020 federal COVID-19-driven granting opportunities initiated the first official QRDR effort in Canadian history, engaging social scientists to rapidly address the pandemic-related societal influences. This study aims to portray the landscape of this nascent social science QRDR workforce through the first round of federal COVID-19-specific grant recipients. A case study approach was employed to analyze 337 social science projects with 1119 associated researchers, examining the demographic structure of these COVID-19-driven social science researchers and their research projects' characteristics. Accordingly, the findings are presented through the following two streams: (1) From a researcher perspective, this case study describes researcher typology, geographic location, primary discipline, and educational background, highlighting the diverse characteristics of social sciences researchers, and uneven research development across Canada. (2) From a research project perspective, this case study identifies and synthesizes research project subjects, themes, collaborations, and Canadian distinctions, emphasizing the need for galvanizing cooperation and focusing on uniquely Canadian contexts. The case study illustrates challenges associated with data curation that pose barriers to developing a nuanced understanding of the Canadian social science community COVID-19 research landscape. Consequently, the case study develops three recommendations to improve QRDR development in Canada: promoting information transparency, dissemination, and updates; improving hazards and disaster research workforce evaluation; and enhancing multi-stakeholder cooperation. [ABSTRACT FROM AUTHOR]

From an out-of-province/state and international post-secondary student perspective, this article (a) explores mass email risk communication facilitation during the COVID-19-triggered campus-wide evictions in Canada and the United States; and (b) develops relative recommendations to improve mass email risk communication strategies for future emergency response. Investigating mass email risk communication-related impacts on students in a tertiary educational context has revealed a significant deficit in emergency response research, practice, and policymaking. Mandatory temporary university and college closures during the COVID-19 first wave provided an opportunity to address this research and practice deficit, as most Canadian and American universities/colleges administered their eviction communication via daily mass email chains. Through a phenomenological lens, this study interviewed twenty out-of-province/state and international students, ten from each country respectively, to examine student eviction experiences associated with intensive mass email risk communication. This research identified four factors linked to mass email risk communication: email chain characteristics, student interpretation, interdepartmental cooperation, and frontline voices. Synthesizing these findings, four evidence-based recommendations were developed: to efficiently convey risk information to students, to understand student perceptions and to inform their behaviors, to enhance interdepartmental cooperation, and to enable mutual dialogue in decision making. These recommendations could assist post-secondary institutions, and other organizations, in strengthening their mass email risk communication strategies and advancing organizational emergency response plans for future extreme events. [ABSTRACT FROM AUTHOR]

Quick response research conducted by social scientists in the aftermath of a disaster can reveal important findings about hazards and their impacts on communities. Research to collect perishable data, or data that will change or be lost over time, immediately following disaster has been supported for decades by two programs in the United States, amassing a collection of quick response studies and an associated research culture. That culture is currently being challenged to better address power imbalances between researchers and disaster-affected participants. Until recently, Canada has not had a quick response grant program. In order to survey the state of knowledge and draw from it in helping to shape the new program in Canada, this article systematically analyzes the body of research created by the two US programs. The results reveal a wide-ranging literature: the studies are theoretically, conceptually, topically, and methodologically quite unique to one another. This diversity might appropriately reflect the nature of disasters, but the finding that many studies are not building on previous quick response research and other insights indicate opportunities for how a new grant program in Canada can contribute to growing a robust subdiscipline of disaster research. [ABSTRACT FROM AUTHOR]

The cataclysmic COVID-19 pandemic erupted silently causing colossal impact worldwide, the repercussions of which indicated a lackadaisical vigilance in preparation for such a pandemic. This review assessed the measures taken by nations to contain this pandemic. A literature review was conducted using Medline, Google Scholar, Science Direct, Scopus, and WHO website. There were 8 nations (selected from the GHS index list) appraised for containment strategies. This was achieved by using mortality rate (per million) as the primary endpoint. The nations which were proactive, initiated scientific strategies earlier with rigor, appeared to have succeeded in containing the pandemic, although it is still too early to arbitrate a verdict. The so called "pandemic war" mandates international, interdisciplinary, and interdepartmental collaboration. Furthermore, building trust and confidence between the government and the public, having transparent communication, information sharing, use of advanced research-technology, and plentiful resources are required in the fight against COVID-19. [ABSTRACT FROM AUTHOR]

Background: Our objective was to establish a sustainable educational partnership and clinical exchange between the trauma services at Vancouver General Hospital (VGH) and the Mexican Red Cross hospital in Mexico City (Hospital Central de la Cruz Roja [HCCR] Polanco).Methods: In 2017, a general surgery resident in postgraduate year 4 travelled from VGH to HCCR Polanco for the initial exchange, followed by a trauma fellow. The surgical case volumes in a month at VGH and a month at HCCR Polanco were compared. At the end of the exchange, a 36-item Likert style questionnaire was administered to the Mexican surgeons and residents who interacted with the Canadian resident and fellow during the exchange.Results: The most commonly performed procedures on the VGH acute care surgery service were laparoscopic cholecystectomy (35%) and laparoscopic appendectomy (17%). The most commonly performed procedures on the VGH trauma service were chest tube insertions (24%) and tracheostomies (24%). The most commonly performed procedures at HCCR Polanco were surgery for penetrating abdominal trauma (19%) and extremity trauma (13%). The survey results indicated that the costs of travel and accommodation were obstacles to future exchanges. All survey respondents wanted to continue collaborating with Canadians on clinical and research endeavours, felt that hosting Canadian residents was a valuable experience and felt that visiting VGH would also be valuable.Conclusion: Canadian surgical trainees gained valuable exposure to operative trauma during the exchange. The mix of operations performed at VGH and HCCR Polanco was vastly different; therefore, the exchange broadened the trainees' surgical experience. There was a unanimously positive response to the exchange among the Mexican survey respondents. This exchange is part of a long-term collaboration between our surgical centres. [ABSTRACT FROM AUTHOR]

Almost every year, First Nations are evacuated in Canada because of wildfire proximity and smoke. Dynamics of wildfires, and remote locations, unique sociocultural characteristics, and limited emergency management resources present challenges for evacuation organizers and residents. This study explores how Dene Tha' First Nation evacuated their Taché community in July 2012 due to wildfire smoke and how the evacuation process affected evacuees. Interviews were completed with 31 evacuation organizers and residents to examine the factors that helped and hindered the evacuation process. Lack of information about the nearby wildfire, smoke, and evacuation of the nearby small community of Zama City, combined with a generic evacuation plan, delayed and posed challenges during the evacuation of this Dene Tha' community. Strong leadership and its role in community organizing, keeping families together, providing the social support they needed, and using familiar host communities, demonstrated and contributed to the community's resilience during the evacuation. Measures to improve evacuations and emergency management in the community and other First Nations in Canada are identified and discussed. [ABSTRACT FROM AUTHOR]

Introduction: Journal club holds a well-respected place in medical education by promoting critical review of the literature and fostering scholarly discussions. Journal clubs are often not available to trainees with niche interests due to the geographic limitations of subspecialty programs such as simulation, medical education, disaster medicine, ultrasound, global health, and women's health. Methods: A recurring online journal club was held on a quarterly basis to connect simulation fellows. An online conferencing program with screen-sharing capabilities served as the platform for this scholarly exchange. Articles were presented by fellows supported by more seasoned mentors. We surveyed participants to evaluate the program and provide feedback to the presenter. Results: The first eight sessions drew participants from across the United States and Canada. The program was highly rated by participants who commented specifically on its value. Presenters were also highly rated, suggesting that fellows, with online support and mentoring, were effective in providing a quality program. Conclusion: Online synchronous journal clubs can fill an educational niche for subspecialists and their trainees, as demonstrated with this curriculum piloted with simulation fellows. Challenges of scheduling across time zones, distribution of materials, and recruitment of participants can be overcome by a dedicated team of facilitators aided by readily accessible technology. [ABSTRACT FROM AUTHOR]

Automatic detection and extraction of buildings from aerial images are considerable challenges in many applications, including disaster management, navigation, urbanization monitoring, emergency responses, 3D city mapping and reconstruction. However, the most important problem is to precisely localize buildings from single aerial images where there is no additional information such as LiDAR point cloud data or high resolution Digital Surface Models (DSMs). In this paper, a Deep Learning (DL)-based approach is proposed to localize buildings, estimate the relative height information, and extract the buildings' boundaries using a single aerial image. In order to detect buildings and extract the bounding boxes, a Fully Connected Convolutional Neural Network (FC-CNN) is trained to classify building and non-building objects. We also introduced a novel Multi-Scale Convolutional-Deconvolutional Network (MS-CDN) including skip connection layers to predict normalized DSMs (nDSMs) from a single image. The extracted bounding boxes as well as predicted nDSMs are then employed by an Active Contour Model (ACM) to provide precise boundaries of buildings. The experiments show that, even having noises in the predicted nDSMs, the proposed method performs well on single aerial images with different building shapes. The quality rate for building detection is about 86% and the RMSE for nDSM prediction is about 4 m. Also, the accuracy of boundary extraction is about 68%. Since the proposed framework is based on a single image, it could be employed for real time applications. [ABSTRACT FROM AUTHOR]

• Sea level rise threatens low-lying coastal regions and highlights the limitations of historically implemented engineering solutions. • Engineering knowledge has contributed to flood risk reduction and flood risk creation. • Diversification of knowledge types used can contribute positively to the resilience of socio-ecological systems. • Knowledge systems used for managing flood resilience across governance scales remain understudied. • Shadow spaces provide a safe space for joint learning, collaborative planning, and knowledge co-production. Drawing on multi-disciplinary literature (socio-ecological resilience, disaster management, and urban planning) this article seeks to uncover what are the knowledge systems that underpin existing flood management regimes and how they enable or constrain learning for future flood risks (sea level rise). The article is situated in a case study of flood and climate risk governance in Canada's Metro Vancouver region. Drawing on 60 interviews with emergency managers, engineers, planners, and elected officials, and a regional survey of resilience practitioners, we identify distinct knowledge systems used for managing urban resilience. We find that technical hazard- and engineering-based knowledge that has maintained its supremacy over the past decades is being increasingly challenged through knowledge co-production. We find that formalized and shadow spaces for learning and collaborative problem-solving break down barriers and enable a collective search for flood resilience solutions across governance levels. [ABSTRACT FROM AUTHOR]

In June 2013, a severe flooding of the Bow and Elbow Rivers affected southern Alberta, a province in Canada. The flood was subsequently described to be the costliest natural disaster in Canadian history. Among the hardest hit communities was the Siksika First Nation, located on the Bow River banks about 100 kilometers east of the city of Calgary. A community-university partnership was formed to qualitatively document the Siksika First Nation community-based response to the health and social impacts to their community resulting from the flood. Our findings informed the development of a culturally appropriate framework for disaster and emergency planning in First Nations communities. The Siksika Nation's work to mitigate the impacts from the flood followed a holistic and socio-ecological approach that took the determinants of Indigenous peoples' health into consideration. [ABSTRACT FROM AUTHOR]

Introduction: Communicating risk to the public continues to be a challenge for public health practitioners working in the area of climate change. We conducted a scoping literature review on the evaluation of risk communication for extreme weather and climate change to inform local public health messaging, consistent with requirements under the Ontario Public Health Standards (OPHS), which were updated in 2018 to include effective communication regarding climate change and extreme weather. Methods: Search strategies were developed by library information specialists and used to retrieve peer-reviewed academic and grey literature from bibliographic databases (Medline, Embase, Scopus and CINAHL) and Google country specific searches, respectively. The search strategy was validated through a workshop with experts and community stakeholders, with expertise in environment, health, emergency management and risk communication. Results: A total of 43 articles were included. These articles addressed issues such as: climate change (n = 22), flooding (n = 12), hurricane events (n = 5), extreme heat (n = 2), and wild fires (n = 2). Studies were predominantly from the US (n = 14), Europe (n = 6) and Canada (n = 5). Conclusion: To meet the OPHS 2018, public health practitioners need to engage in effective risk communication to motivate local actions that mitigate the effects of extreme weather and climate change. Based on the scoping review, risk communication efforts during short-term extreme weather events appear to be more effective than efforts to communicate risk around climate change. This distinction could highlight a unique opportunity for public health to adapt strategies commonly used for extreme weather to climate change. [ABSTRACT FROM AUTHOR]

Context: The potential for disasters and public health emergencies is increasing globally, requiring expertise and capacity to mitigate and manage such events. Individuals with prior international disaster response represent an essential source of expertise to support disaster response in their home countries. Objective: The objective of this study was to explore the experiences of healthcare personnel involved in international emergency response regarding their perceptions of the individual attributes and collective team capacities during disaster response and how this may benefit disaster management in Canada. Study design and analysis: This descriptive qualitative research study consisted of semi-structured interviews with key informants. Interviews were audio-recorded and transcribed. Conventional content analysis was performed on the transcripts, and themes were developed. Setting: Interviews were either conducted over the phone or in person. Population studied: Participants were delegates involved with the Canadian Red Cross medical response team, and who acted in a clinical or technical (physicians, surgeons, nurses) or administrative role (team leaders, administrators) within the last 5 years. Instrument: Semi structured interview guide was designed and piloted. It included open ended questions that explored participants' experience on medical emergency response team and related lessons learned in terms of skills and capacities acquired. Outcome measures: Participant narratives of individual skills and team capacities acquired during disaster response and how these skills and capacities can be applied domestically in Canada. Results: Eighteen key informants provided perspectives on individual attributes acquired during international deployments, (ex; agility, stress management), and team capacities developed, including collaboration and conflict management. Key informants included nurses, physicians, technicians, and administrators and described these experiences as highly relevant to the domestic context. Conclusions: Canadian physicians and healthcare workers involved with international disaster response have already acquired essential capacities, and this experience can be vital to building efficient disaster response teams. These findings complement the CanMEDS roles and can inform course design, competency and curriculum development for family medicine and primary care professional training programs related to disaster response. [ABSTRACT FROM AUTHOR]

Context. The Advanced Access (AA) model was developed 20 years ago by Murray et al. and has been implemented in several countries. Over the last two decades, primary healthcare practice has evolved to increase interdisciplinarity in clinical teams. Thus, the need for a model that incorporates new professionals has necessitated development of a revised AA model. Objective. We aim to revise the pillars and sub-pillars of the AA model based on its contemporary practice by professionals in primary healthcare as well as their operationalization. Study Design. This s sequential multi-method consultation process was informed by a literature synthesis of 41 articles followed by a three-phase consultation with 45 AA experts: 1) a deliberative face-to-face meeting; 2) an e-survey; and 3) two final virtual validation meetings Setting. AA Experts from across the province of Quebec, Canada. Population studied. The panel of experts represented provincial and local decision-makers, primary healthcare clinic members (family physicians, nurses and administrative staff), patients and researchers Outcome Measures: Throughout the consultation process, participants were asked to develop a common vision of the pillars and sub-pillars that make up the revised AA model and react to suggested definitions or content. Instrument. The final consensual AA model pillars and their operational definitions. Results. The revised AA model is defined by five pillars: two were updated from the original model ("Appointment system" and "Interprofessional practice"), one was merged with a revised pillar ("Develop contingency plans" with "Planning of needs and supply"), and another one underwent major changes (from "Backlog reduction" to "Continuous adjustment"); finally, An emerging new pillar concerns the communication process. Subsequent steps for operationalizing definitions of sub-pillars confirmed the nature of the revised AA pillars and stabilized their content. Conclusion. The revised contemporary AA model that obtained strong consensus among participating experts and reflects contemporary practice in Canada. The revised model will be used to develop a reflective tool for primary healthcare professionals to evaluate their AA practice. [ABSTRACT FROM AUTHOR]

The snow and avalanche climate types maritime, continental and transitional are well established and have been used extensively to characterize the general nature of avalanche hazard at a location, study inter-seasonal and large-scale spatial variabilities and provide context for the design of avalanche safety operations. While researchers and practitioners have an experience-based understanding of the avalanche hazard associated with the three climate types, no studies have described the hazard character of an avalanche climate in detail. Since the 2009/2010 winter, the consistent use of Statham et al. (2017) conceptual model of avalanche hazard in public avalanche bulletins in Canada has created a new quantitative record of avalanche hazard that offers novel opportunities for addressing this knowledge gap. We identified typical daily avalanche hazard situations using selforganizing maps (SOMs) and then calculated seasonal prevalence values of these situations. This approach produces a concise characterization that is conducive to statistical analyses, but still provides a comprehensive picture that is informative for avalanche risk management due to its link to avalanche problem types. Hazard situation prevalence values for individual seasons, elevations bands and forecast regions provide unprecedented insight into the inter-seasonal and spatial variability of avalanche hazard in western Canada. [ABSTRACT FROM AUTHOR]

The Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP) is a guidance document that outlines key health sector preparedness activities designed to ensure Canada is ready to respond to the next influenza pandemic. This article outlines Canada's pandemic influenza laboratory strategy as described in the CPIP Laboratory Annex. Laboratory identification and characterization of an influenza pandemic virus is critical to detect the pandemic, develop a vaccine, detect antiviral resistance and inform surveillance functions such as monitoring the geographic spread of the disease. Key elements of the laboratory response will include ensuring there are adequate resources for all activities. Pre-analytical activities include the appropriate collection, transport to the laboratory, triaging and preparation of specimens. Analytical activities refer to the different testing methods for the detection of influenza, including maintaining the ability to culture influenza virus for genetic and antigenic characterization. Post-analytic activities include ensuring front-line and provincial public health laboratories work together to make data and specimens available for surveillance purposes. In the inter-pandemic period, it is important to develop the infrastructure, protocols and processes to enable rapid-response research during a pandemic. This is an evergreen document that will be updated regularly. [ABSTRACT FROM AUTHOR]

The Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP) is a guidance document that outlines key health sector preparedness activities designed to ensure Canada is ready to respond to the next influenza pandemic. This article outlines Canada's pandemic influenza surveillance strategy as described in the CPIP Surveillance Annex. The strategy builds on the surveillance activities used for seasonal influenza and incorporates lessons learned from the 2009 H1N1 pandemic, including improved information sharing, improved electronic links among Federal/Provinical/Territorial (FPT) partners and improved surveillance for Indigenous communities. Key elements of the surveillance strategy include early detection and investigation of a novel influenza virus through the reporting of cases or clusters of severe acute respiratory infections and laboratory detections of novel influenza viruses. Community-based surveillance will provide information on clinical severity, age groups affected and risk factors associated with severe disease. Severe outcome surveillance will capture data on hospitalizations and deaths. Laboratory surveillance will include weekly reports of respiratory virus detections. The response activities are adaptable to the demands of different levels of pandemic activity and impact, supported by a set of triggers for the activation and deactivation. Surveillance will be linked with other response components, such as communications, research, assessment and evaluation. This is an evergreen document that will be updated regularly. [ABSTRACT FROM AUTHOR]

Pandemic preparedness requires a multifaceted approach with collaboration from all levels of government. The Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP) is a guidance document that outlines key health sector preparedness activities designed to ensure Canada is ready to respond to the next influenza pandemic. This article outlines Canada's approach to pandemic influenza preparedness as described in the CPIP Main Body. Canada's pandemic influenza preparedness planning takes place within a network of legislated requirements and emergency frameworks at provincial/territorial, federal and international levels. The plan includes several guiding principles, including collaboration among governments and stakeholders, evidence-based decision-making, proportionality and flexibility in tailoring responses to the situation, the adoption of a precautionary approach, the use of established practices and systems and the explicit incorporation of ethical principles in all decisions and decision-making processes. The roles and responsibilities of the federal and provincial/territorial governments is identified and three planning tools are provided: planning assumptions rooted in evidence; multiple scenarios to support decision-making; and descriptive terms such as the start, peak and end of pandemic wave rather than phase terminology to provide triggers for action. Overall, the CPIP Main Body sets out a scalable, coordinated risk management approach to an influenza pandemic. This is an evergreen document that will be updated regularly. [ABSTRACT FROM AUTHOR]

In light of recent disasters in the oil and gas industry, there is increasing public pressure to develop more robust processes for responding to such disasters in Canada. In this article, the authors examine the emergency response procedures currently in place, and consider how oil and gas producers, carriers, and processors can improve these procedures. The article begins by outlining the emergency response planning and incident reporting obligations incumbent on the oil and gas industry, which is followed by an overview of the regulatory inspection powers that exist to investigate real and potential environmental, workplace, and safety incidents. Finally, the article considers what responding to an actual emergency would look like, and proposes best practices for the oil and gas industry. [ABSTRACT FROM AUTHOR]

Heat waves result in significant excess mortality, particularly amongst elderly people. This article examines selected heat wave response plans at national, state/provincial, and municipal levels, with a particular focus on specific responses aimed at residents of aged care facilities. We sourced heat wave response plans from several countries that are experiencing a demographic transition that features a growing aging population. We collected a total of 23 heat wave response plans; most of the plans were from Australia, with only three plans each available from Canada and the UK, and only two available from the U.S. Key components found across the plans were analysis of temperature thresholds, heat stress prevention measures, and communication strategies. Only three heat wave response plans that we analyzed included specific guidance for aged care facilities. Projected increases in frequency and duration of heat waves in coming decades underline the need for governments to implement effective guidelines that include specific provisions for aged care facilities. [ABSTRACT FROM AUTHOR]

Background: The impact of heat waves on mortality and health inequalities is well documented. Very few studies have assessed the effectiveness of heat action plans (HAPs) on health, and none has used quasi-experimental methods to estimate causal effects of such programs. Objectives: We developed a quasi-experimental method to estimate the causal effects associated with HAPs that allows the identification of heterogeneity across subpopulations, and to apply this method specifically to the case of the Montreal (Quebec, Canada) HAP. Methods: A difference-in-differences approach was undertaken using Montreal death registry data for the summers of 2000-2007 to assess the effectiveness of the Montreal HAP, implemented in 2004, on mortality. To study equity in the effect of HAP implementation, we assessed whether the program effects were heterogeneous across sex (male vs. female), age (≥ 65 years vs. < 65 years), and neighborhood education levels (first vs. third tertile). We conducted sensitivity analyses to assess the validity of the estimated causal effect of the HAP program. Results: We found evidence that the HAP contributed to reducing mortality on hot days, and that the mortality reduction attributable to the program was greater for elderly people and people living in low-education neighborhoods. Conclusion: These findings show promise for programs aimed at reducing the impact of extreme temperatures and health inequities. We propose a new quasi-experimental approach that can be easily applied to evaluate the impact of any program or intervention triggered when daily thresholds are reached. Citation: Benmarhnia T, Bailey Z, Kaiser D, Auger N, King N, Kaufman J. 2016. A difference-indifferences approach to assess the effect of a heat action plan on heat-related mortality, and differences in effectiveness according to sex, age, and socioeconomic status (Montreal, Quebec). Environ Health Perspect 124:1694-1699; http://dx.doi.org/10.1289/EHP203 [ABSTRACT FROM AUTHOR]

The article focuses on the Inter-Parliamentary Union's 2010 report which found that parliamentarians have important role in influencing national policies. It discusses risks faced by British Columbia from natural disasters, industrial accidents and terrorism, and mentions that British Columbia Provincial Government has established the Ministry on emergency management in Canada to overcome the problem.

The Public Health Agency of Canada (the Agency) has an important role to play in collaboration with its provincial/territorial partners to advance preparedness for emerging and re-emerging high-consequence infectious diseases. During the 2014 Ebola outbreak, the Agency established Ebola Virus Disease (EVD) Rapid Response Teams that were available to any requesting provincial/territorial jurisdiction with a laboratory confirmed case of EVD. Working with provincial and territorial officials, a Rapid Response Team Concept of Operations was developed which outlined the process for Rapid Response Team engagement as well as the suite of technical expertise available. The Concept of Operations was refined further following a series of face-to-face advance planning meetings with individual provincial and territorial jurisdictions. This led to a consensus agreement that the Agency's Rapid Response Team should be available to support management of both confirmed and suspected EVD cases. There was also unanimous support from provincial and territorial jurisdictions that the concept and operationalization of the Agency's Rapid Response Team should be broadened to provide surge-capacity support to the provinces and territories to include any event with significant public health consequences. The Agency will continue to engage with domestic and international partners regarding best practices to maintain a highly skilled and nimble Rapid Response Team that is operationally ready to support both domestic and international public health emergencies. [ABSTRACT FROM AUTHOR]

Summary: The 1917 Halifax Explosion was an unfortunate but predictable tragedy, given the sea traffic and munitions cargo, resulting in sudden large-scale damage and catastrophic injuries, with 1950 dead and 8000 injured. Although generous support was received from the United States, the bulk of the medical work was undertaken using local resources through an immediate, massive, centrally coordinated medical response. The incredible care provided 100 years ago by these Canadian physicians, nurses and students is often forgotten, but deserves attention. The local medical response to the 1917 disaster is an early example of coordinated mass casualty relief, the first in Canada, and remains relevant to modern disaster preparedness planning. This commentary has an appendix, available at canjsurg.ca/016317-a1. [ABSTRACT FROM AUTHOR]

Three recent Canadian public health crises present an illustration of both the opportunities for reform and the challenges that may impede progress and public health renewal in federalist nations. While the three crises examined exposed serious flaws in emergency preparedness and fuelled demands for vital public health reform, evidence indicates that fundamental challenges have not been addressed and may have even heightened over the last decade given a move to 'open federalism" and the significant fiscal impacts of ongoing austerity measures. With future pandemics inevitable, we identify the missed opportunities to optimize Canada's emergency response capacity and procedures and examine the seemingly intractable barriers of federalism and path dependency thinking that continue to impede learning and reform and ultimately undermine effective disaster management [ABSTRACT FROM AUTHOR]

Insurance coverage of damage caused by overland flooding is currently not available to Canadian homeowners. As flood disaster losses and water damage claims both trend upward, insurers in Canada are considering offering residential flood coverage in order to properly underwrite the risk and extend their business. If private flood insurance is introduced in Canada, it will have implications for the current regime of public flood management and for residential vulnerability to flood hazards. This paper engages many of the competing issues surrounding the privatization of flood risk by addressing questions about whether flood insurance can be an effective tool in limiting exposure to the hazard and how it would exacerbate already unequal vulnerability. A case study investigates willingness to pay for flood insurance among residents in Metro Vancouver and how attitudes about insurance relate to other factors that determine residential vulnerability to flood hazards. Findings indicate that demand for flood insurance is part of a complex, dialectical set of determinants of vulnerability. [ABSTRACT FROM AUTHOR]

Ethnography is a qualitative methodology facilitating in-depth research into groups sharing a common organizational culture. The purpose of this ethnographic study is to discover obstacles and opportunities for the proposed use of citizen volunteers in the Vancouver Fire & Rescue Services (VF&RS) located in Vancouver, British Columbia (BC), Canada. As proposed, volunteers would be organized into Neighborhood Emergency Assistance Teams (NEATs) and activated for use in disaster events falling outside the normal scope of emergency response. Development of the NEAT program is an effort by VF&RS and the City of Vancouver (CoV) to acknowledge the necessity and critical nature of engaging communities as a means of preparing for catastrophic events (Reynolds, 2012; VF&RS, 2011). Data gathered from semistructured interviews of 26 firefighters and 4 subject-matter experts (SMEs), for a total sample size of 30, were analyzed using thematic network analysis to discover common themes in attitudes and perceptions among the respondents concerning the use of volunteers in delivering fire and rescue services. Emerging from the analysis were 16 basic themes that were collapsed into five organizing themes that, in turn, were organized into two global themes. Global Theme 1, organizational and cultural aspects of the fire service impede innovation and progress in the area of disaster management, points to obstacles in the use of volunteers in the VF&RS. In contrast, Global Theme 2, participatory approaches to disaster management enhance capacity and resiliency of the fire service and society, suggests that interviewees believe the use of volunteers through the NEAT program holds considerable promise for delivering disaster-management services in Vancouver. The article concludes with 14 policy recommendations that provide the VF&RS the opportunity to enhance the development of comprehensive disaster emergency management through strategies incorporating the use of citizen volunteers. [ABSTRACT FROM AUTHOR]

This study explores flood-related environmental injustices by deconstructing racial, ethnic, and socio-demographic disparities and spatial heterogeneity in the areal extent of fluvial, pluvial, and coastal flooding across Canada. The study integrates JBA Risk Management's 100-year Canada Flood Map with the 2016 national census-based socioeconomic data to investigate whether traditionally recognized vulnerable groups and communities are exposed inequitably to inland (e.g., fluvial and pluvial) and coastal flood hazards. Social vulnerability was represented by neighbourhood-level socioeconomic deprivation, including economic insecurity and instability indices. Statistical analyses include bivariate correlation and a series of non-spatial and spatial regression techniques, including ordinary least squares, binary logistic regression, and simultaneous autoregressive models. The study emphasizes the quest for the most appropriate methodological framework to analyze flood-related socioeconomic inequities in Canada. Strong evidence of spatial effects has motivated the study to test for the spatial heterogeneity of covariates by employing geographically weighted regression (GWR) on continuous outcome variables (e.g., percent of residential properties in a census tract exposed to flood hazards) and geographically weighted logistic regression on dichotomous outcome variables (e.g., a census tract in or out of flood hazard zone). GWR results show that the direction and statistical significance of relationships between inland flood exposure and all explanatory variables under consideration are spatially non-stationary. We find certain vulnerable groups, such as females, lone-parent households, Indigenous peoples, South Asians, the elderly, other visible minorities, and economically insecure residents, are at a higher risk of flooding in Canadian neighbourhoods. Spatial and social disparities in flood exposure have critical policy implications for effective emergency management and disaster risk reduction. The study findings are a foundation for a more detailed investigation of the disproportionate impacts of flood risk in Canada. [ABSTRACT FROM AUTHOR]

• Experience increases hazard prioritization and the number of responses in place. • Less physically visible hazards are underestimated by coastal municipalities. • Information and expertise are crucial for municipalities' hazard response capacity. • Resolving municipalities' identified needs and priorities could support hazard responses. • Integrated coastal governance and management could strengthen local response capacity. As climate and anthropogenic changes increase the vulnerability of coastal areas around the world, the threat (and reality) of coastal hazards grows. These threats arise particularly at a local level, calling out for more knowledge on how to best support coastal municipalities to deal with natural and human-induced hazards. This study seeks to add to the understanding through an examination of local-level experience with hazard planning and responses carried out by coastal municipalities, producing insights on how to reduce their vulnerability and support their resilience. It explores the factors influencing coastal municipalities' management of relevant hazards to achieve comprehensive multi-hazard risk reduction and adaptation. We do so through a national survey of Canada's coastal municipalities which assessed experience with hazards, risk perception, hazard prioritization, and the extent and specifics of hazard responses. We characterize the determinants of coastal municipalities' behaviour and intervening factors, and conduct regression analyses to explain coastal municipalities' risk perception, hazard prioritization, implementation of management processes for dealing with hazards, and the number of implemented or planned hazard responses. Six key factors were identified that influence hazard responses at the municipal level: experience with hazards; competing priorities; hazard visibility; access to resources (financial and technical capacity) and governance (institutional setting and political capacity). We conclude that municipal hazard responses can be reinforced by increasing the effectiveness of risk communication, promoting participatory processes, providing support for municipalities' identified needs and priorities, ensuring municipalities have access to relevant information and expertise, and implementing integrated coastal governance and management. [ABSTRACT FROM AUTHOR]

• The seismic resilience quantification of reinforced masonry shear wall buildings. • Fragility surfaces of the reinforced masonry shear walls with boundary elements. • Bidirectional horizontal seismic excitation. • Out-of-plane contribution of shear walls. • Probabilistic seismic resilience qunatification. The concept of resilience is gaining increased attention in disaster management due to the recent awareness of the need to reduce the detrimental post-event effects of natural disasters, e.g., earthquakes. Resilience is a practical concept that includes pre-event (preparedness and mitigation) and post-event (response and recovery) activities. Quantitative resilience assessment approaches are needed to compare the available mitigation strategies to decide on the most suitable strategy and provide better support for decision-making procedures. In this study, a methodology for quantifying the seismic resilience of reinforced masonry shear wall (RMSW) buildings with end-confined masonry boundary elements is implemented. The uncertainties associated with structural and non-structural losses and estimated recovery time uncertainties are considered while quantifying the resilience index of RMSW buildings. The archetype buildings studied have 8-, 10-, and 12-storey heights and are located in Vancouver, representing a high seismic zone in Canada. First, a numerical model was developed using OpenSees to derive the fragility surface for the studied archetypes subjected to bi-directional horizontal excitation. Second, a Monte Carlo simulation was performed to quantify the resilience index of each archetype considering the above-mentioned uncertainties. The results prove the robustness of ductile RMSW buildings having end-confined MBEs in mitigating the losses associated with disaster events. Additionally, the findings provide comprehensive and valuable information for earthquake mitigation measures and disaster risk reduction programmes. [ABSTRACT FROM AUTHOR]

The article provides the author's view on issues related to implementing child care programs at the University of Ottawa in Canada. She mentions her reaction about an announcement made by the school administration telling faculty members not to bring children to the workplace as children do not know what to do during fire drills and that the school is not insured in the case of injury.

Canadian emergency management planners have historically ignored the self-motivated evacuation procedures of people who cannot initially choose the safest evacuation areas. In densely developed urban areas, open spaces can be seen as ideal evacuation areas and should thus be included in shelter planning. In this study, the public open spaces in Great Victoria were selected as the study area and evaluated using GIS technologies. A multi-criteria TOPSIS evaluation model was used to conduct comprehensive quantitative evaluations of the open spaces' safety, accessibility, and availability. Through hybrid process, service area, and POI aggregation coupling analyses, a model is created that provides an overall evaluation at the district level. In addition to providing a model for evaluating open spaces as emergency shelters, applicable to most Canadian cities, this study emphasizes the importance and disadvantages of open space emergency shelters in Canada, which have heretofore been ignored by decision makers. In Great Victoria, we found that the distribution of open spaces does not match the dynamics of the population distribution, meaning that through inadequate preparation some districts lack a safe evacuation place—this in an area where people are at high risk of earthquake disasters and their subsequent effects. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been a wake-up call for many aspects of our daily lives. Nurse regulators have had to respond quickly to many of the challenges that the profession has faced. Some solutions have been formulated on sound evidence and represent an appropriate and rational response to what could be described as long-overdue change. Other solutions have been less than ideal and have functioned as a stopgap or trade-off between two or more less than ideal scenarios. In this article we begin with a brief synopsis of pandemics. We then describe the method, results and discussion, and limitations of our analysis of legislative changes pertinent to professional regulation. Our analysis and conclusions reflect on lessons learned, identify opportunities that should be consolidated into permanent change, and discuss issues that need to be addressed if we are to be better prepared for the next pandemic. [ABSTRACT FROM AUTHOR]

Background: Disasters and emergencies from infectious diseases, extreme weather and anthropogenic events are increasingly common. While risks vary for different communities, disaster and emergency preparedness is recognized as essential for all nation-states. Evidence to inform measurement of preparedness is lacking. The objective of this study was to identify and define a set of public health emergency preparedness (PHEP) indicators to advance performance measurement for local/regional public health agencies. Methods: A three-round modified Delphi technique was employed to develop indicators for PHEP. The study was conducted in Canada with a national panel of 33 experts and completed in 2018. A list of indicators was derived from the literature. Indicators were rated by importance and actionability until achieving consensus. Results: The scoping review resulted in 62 indicators being included for rating by the panel. Panel feedback provided refinements to indicators and suggestions for new indicators. In total, 76 indicators were proposed for rating across all three rounds; of these, 67 were considered to be important and actionable PHEP indicators. Conclusions: This study developed an indicator set of 67 PHEP indicators, aligned with a PHEP framework for resilience. The 67 indicators represent important and actionable dimensions of PHEP practice in Canada that can be used by local/regional public health agencies and validated in other jurisdictions to assess readiness and measure improvement in their critical role of protecting community health. [ABSTRACT FROM AUTHOR]

This article describes the formation of the International Pharmacists-as-Immunizers Partnership (IPIP), an international network of pharmacy practice researchers with an interest in pharmacist-administered immunizations. Using funds obtained from a university-sponsored grant, a two-day meeting was held at the University of Waterloo in Canada to discuss published and in-progress research on the topic, identify gaps and priorities for future research, and share implementation strategies used in different jurisdictions. Twelve researchers from five countries attended this initial meeting, identified from both personal networks and from authorship lists from published research. Small- and large-group discussions addressed a number of themes, including: clinical, economic and educational outcomes of the service; the perspectives of pharmacists, patients, and other health professionals; operational and policy factors influencing uptake; safety; and the immunizing pharmacist's role in disaster preparedness. Feedback on our first meeting and outcomes achieved were evaluated on the basis of participant feedback. Key components of the meeting that were considered successful and important lessons learned are summarized, so that other like-minded researchers with a shared pharmacy practice research interest could consider leveraging funding opportunities to establish other international pharmacy practice research networks. [ABSTRACT FROM AUTHOR]

A review of the article "A Difference-in-Differences Approach to Assess the Effect of a Heat Action Plan on Heat-Related Mortality, and Differences in Effectiveness According to Gender, Age, and Socioeconomic Status (Montreal, Quebec)" by Tarik Benmarhnia et al. which appears in the same issue.