Search

Burn mass casualty incident (BMCI) preparedness is lacking across Canada. A focused exploration of the current policies, protocols and practices in Alberta that address the response to a BMCI was conducted. In this case study, data were gathered from documents outlining the health system response to a mass casualty incident and health care professionals directly involved. Interviews were conducted online, recorded and transcribed. Qualitative description was used to code common themes across documents and transcripts. Fifteen documents and nine participant interviews were included in this study. Overall, the current policies, protocols and practices in place were limited to all-hazards mass casualty incident planning and did not address the specialized needs of burn patients. Deficiencies included no burn-specific plan at each of the two burn centres, a lack of provincial-level recognition of the unique challenges associated with a BMCI and no established Canadian burn disaster communication plan. Suggestions of strategies for a burn plan included forward triage, patient movement, use of telemedicine, partnering skilled and non-skilled staff, and procuring additional supplies. For best patient outcomes the provincial health authority needs to provide dedicated time for burn care experts to develop BMCI response plans to better address this unique hazard. • All hazards mass casualty (MC) plans do not work for multiple burn injured patients. • Participant communication and decision-making practices deviated from the MC plan. • Participants expressed concerns about the overall ability to respond to a burn MC. • Creating burn capacity includes strategies for space, staffing, and supplies needed. [ABSTRACT FROM AUTHOR]

The climate crisis significantly impacts the health and well-being of older adults, both directly and indirectly. This issue is of growing concern in Canada due to the country's rapidly accelerating warming trend and expanding elderly population. This article serves a threefold purpose: (i) outlining the impacts of the climate crisis on older adults, (ii) providing a descriptive review of existing policies with a specific focus on the Canadian context, and (iii) promoting actionable recommendations. Our review reveals the application of current strategies, including early warning systems, enhanced infrastructure, sustainable urban planning, healthcare access, social support systems, and community engagement, in enhancing resilience and reducing health consequences among older adults. Within the Canadian context, we then emphasize the importance of establishing robust risk metrics and evaluation methods to prepare for and manage the impacts of the climate crisis efficiently. We underscore the value of vulnerability mapping, utilizing geographic information to identify regions where older adults are most at risk. This allows for targeted interventions and resource allocation. We recommend employing a root cause analysis approach to tailor risk response strategies, along with a focus on promoting awareness, readiness, physician training, and fostering collaboration and benchmarking. These suggestions aim to enhance disaster risk management for the well-being and resilience of older adults in the face of the climate crisis. [ABSTRACT FROM AUTHOR]

The article provides an overview of various extreme weather events that occurred in 2023. It attributes the global heat to El Niño and global warming, resulting in record-breaking temperatures and droughts in some areas. The year began with extreme heat and cold, accompanied by major flooding in Africa, the Philippines, and New Zealand. The article also mentions the "Zombie Cyclone" that caused heavy rain, high winds, and flooding as it traveled from Indonesia to Madagascar and Mozambique. It further discusses Canada's historic wildfire season, extreme summer heat in North America and Asia, and other notable events such as record-breaking temperatures in Algeria, Morocco, and Albania, scorching temperatures in China, historic flooding in the eastern Mediterranean, deadly monsoon flooding in South Asia, Hurricane Otis in Mexico, and storms in Europe causing flooding and power outages. The article concludes by mentioning the forecasted dissipation of El Niño in 2024, which may result in lower global temperatures. [Extracted from the article]

This paper utilizes a conceptual analysis and targeted literature review to explore public administrative collaboration models in the context of Canadian fire department interagency relationships. It proposes that effective emergency planning and response links are formed and maintained by the use of thoughtful and tailored communication. Numerous working examples of stakeholder relationships for fire departments are explored including other first responding organizations, various government levels, non-governmental organizations (NGOs), media and the public — including special considerations for specific subsets of the population. Operational recommendations are made based on the review of numerous public management and administration research for the creation of effective interagency relationships. These recommendations, while based in Canada, could easily be adapted to analogous fire departments or other first responding organizations internationally. [ABSTRACT FROM AUTHOR]

Recurrent disaster experiences can motivate communities to initiate risk management as part of their resilience mechanism if there is appropriate support to assist their shared commitment and goals. This scenario was evident in the City of Brandon's (Manitoba, Canada) response to the 1-in-300-year high-water event during the spring of 2011. This study examined how this small prairie city/community achieved the creation and preservation of locally driven flood risk management practice, and the critical role of the Brandon Emergency Support Team (BEST), a community-based disaster risk management organization, in facilitating enhanced risk awareness towards protecting the city from flooding. [ABSTRACT FROM AUTHOR]

Historically, governmental responses to homelessness in Canada have defaulted to the most basic of services such as food and shelter. Even under exceptional circumstances, such as the current coronavirus pandemic, governments still demonstrate reluctance to guarantee permanent, adequate and affordable housing to all. In this policy review we argue that this pattern suggests that reticence is an apt term for describing homelessness responses in Canada and that this condition is rooted in the continued dominance of liberalism in Canadian society. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has increased physician burnout beyond high baseline levels. We aimed to determine whether pandemicrelated factors contribute to physician burnout beyond known organizational factors. This was a cross-sectional survey of Canadian physicians using a convenience sample. Eligible participants included any physician currently holding a license to practice in Canada. Responses were gathered from May 13 to 12 June 2020. Risk factors measured included the newly developed Pandemic Experiences and Perceptions Scale (PEPS) subscales, contact with virus, pandemic preparation, and provincial caseload. The primary outcome was the Maslach Burnout Inventory (MBI). The primary outcome was completed by 309 respondents. Latent profile analysis found 107 (34.6%) respondents were burned out. In multivariate analysis, exhaustion was independently associated with PEPS adequacy, risk perception, and worklife subscales (adjusted R2 = 0.236, P < 0.001). Cynicism was associated with exhaustion, and PEPS worklife (adjusted R2 = 0.543, P < 0.001). Efficacy was associated with cynicism, PEPS worklife, and active cases (adjusted R2 = 0.152, P < 0.001). Structural equation modelling showed statistically significant direct paths between PEPS areas of worklife and all MBI subscales. Contact with virus, preparation, and PEPS risk perception added to the prediction of MBI exhaustion. Among a sample of Canadian physicians during the COVID-19 pandemic, adequacy of resources, risk perception, and quality of worklife were associated with burnout indices. To mitigate physician burnout organizations should work to improve working conditions, ensure adequate resources, and foster perceived control of risk of transmission. [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]

The Canadian Prairies are a major grain production region, producing most of the wheat for export in Canada. Global warming and the associated changes in extreme precipitation and temperature events pose significant risks to agriculture on the Canadian Prairies. Compound hazards can cause higher crop failure than isolated events, especially in the main grain production regions in western Canada. To achieve informed climate risk management, it is critical to characterize the threats posed by compound hazards in current and future climates in western Canada. In this study, return periods of events were computed to assess the potential changes in the hotspots for agriculturally relevant compound events in western Canada using two convection‐permitting climate simulations: current (CTL) climate and future climate under the RCP8.5 scenario based on a pseudo‐global‐warming (PGW) approach. Specifically, our study analyzed agricultural drought, low precipitation, heatwaves, and cool waves related to cool‐season crops. The results showed the overall good performance of the CTL simulation in capturing spatial patterns of these compound events in western Canada. In the current climate, droughts and heatwaves co‐occur mostly in southeastern parts of the prairies. Under the RCP8.5 scenario, they are likely to increase in frequency and expand to cover the major croplands of western Canada. This study provides information that policymakers in the fields of climate change adaptation and agricultural disaster management will find useful. [ABSTRACT FROM AUTHOR]

Summary: This qualitative study examined the COVID-19 pandemic as experienced by healthcare-based social workers in relation to practice, and personal and professional impacts of providing care in this context, with recommendations for pandemic preparedness and response. A total of 12 focus groups were convened between June 2020 and March 2021, comprising 67 hospital social workers across multiple hospitals and other care facilities in western Canada. Findings: Based on an Interpretive Description approach, themes emerged reflecting practice shifts; increased work and changing roles; imposed restrictions; problems in communication and decision-making; distress, fear, and demoralization; and co-existing silver linings amid challenges. Applications: The COVID-19 pandemic has substantially impacted social workers and their delivery of service. Addressing concerns through proactive responsiveness, both during and beyond the pandemic, are important in nurturing patient-centered care and a supported workforce. Along with that of interdisciplinary colleagues in health care, social workers' practice has been profoundly impacted by the COVID-19 pandemic. This article explores the experiences of social workers in healthcare settings during the COVID-19 pandemic. [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]

Over the last decade, youth have been acknowledged as agents of change in the fight against climate change, and more recently in disaster risk reduction. However, there is a need for improved opportunities for youth to participate and have their voices heard in both contexts. Our Photovoice study explores youth perceptions of the capability of youth to participate in disaster risk reduction and climate change action. We conducted six focus groups from February 2019 to June 2019 with four teenaged youth participants in Ottawa, Canada, hosting two virtual Photovoice exhibitions in 2021. Our results highlight 11 themes across a variety of topics including youth as assets, youth-adult partnerships, political action on consumerism, social media, education, accessibility, and art as knowledge translation. We provide four calls to action, centering youth participation and leadership across all of them, to guide stakeholders in how to improve disaster risk reduction and climate change initiatives by meaningfully including youth as stakeholders. [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]

Disaster risk reduction is central to managing the risks of climate change at global, national, and sub-national levels. The operationalization of disaster risk reduction, however, has been met with challenges that have restricted successful policy implementation. Drawing from document analyses and Delphi studies with government practitioners, this article examines the policy context for disaster risk reduction in Canada and Australia and investigates the state of flood and drought planning and preparedness. Results are organized around two central themes: risk (ownership and sensitivity) and engagement (stakeholder involvement and capacity-building). The findings show that public policies on disaster risk reduction in Canada and Australia reflect international discourse that advocates for a whole-of-society, risk-sensitive, and risk-informed approach. However, implementing this approach in household planning and preparedness, cross-sector planning and policy integration, terminology, and socio-cultural representation, has been hampered by several factors. Government practitioners in both countries argued that while disaster risk reduction and climate risk management continue to evolve in multi-level governance, policy implementation is constrained by the legacies of past governance arrangements that have enabled disaster risk creation and accumulation. The results presented herein suggest a need for institutional reform that better reflects the holistic and systemic relationships between disaster risk, climate change, and other policy problems. We argue that disaster risk reduction and climate risk management policies require bridging governance arrangements between these and related policy domains to foster effective multi-level implementation. Key policy insights Implementing disaster risk reduction has been inconsistent, exacerbating exposure to climate change and increasing socio-economic vulnerabilities to disaster impacts. Managing climate and disaster risk requires a holistic approach that targets vulnerable groups, tackles underlying drivers of risk, and builds capacities to support disaster risk reduction. Although disaster risk reduction and climate risk management policies continue to evolve, implementation is hindered by legacy governance arrangements that favour economic growth over sustainable, climate-sensitive disaster risk management. Transformation through the integration of disaster risk reduction and human development offers potential pathways to reduce vulnerabilities via a holistic disaster risk and climate policy approach. [ABSTRACT FROM AUTHOR]

This study aims to advance knowledge on multi-hazard damage to shallow foundation bridges subjected to simultaneous scour, earthquake, and vehicular loads. While most water-crossing bridges have deep foundations, still, a significant number of water-crossing bridges have shallow foundations. In addition, there is limited research focusing on damage assessment of bridges with shallow foundations under multi-hazard scenarios. Therefore, this study proposes a probabilistic multi-hazard damage assessment framework for bridges with shallow foundations exposed to seismic, scour, and vehicular loadings. The proposed framework includes steps for hazard modeling, multi-hazard finite element modeling, non-linear time history analysis, and multi-hazard fragility modeling, and it was showcased on Chemin des Dalles Bridge, which is a typical bridge located in the Province of Quebec in Canada. Demand and fragility models parameterized on hazard and soil parameters were developed for the bridge components and a system fragility model was also developed using a series system assumption. The results from the analysis of these damage and fragility models indicated that scour notably increases component- and bridge-level response in typical shallow foundation bridges. However, until the scour depth is lower than the foundation height, the increased damage does not impose a significant threat to the bridge's safety. It was observed that earthquakes had the highest influence on the bridge components' response followed by scour and vehicular loads. Overall, the proposed framework can be used to facilitate policy-making toward informed bridge maintenance and retrofitting to aid in disaster mitigation planning and emergency response. • Novel framework for multi-hazard damage assessment of shallow foundation bridges. • Uniform scour around foundation had little impact on shallow foundation bridges. • Influence of hazards, high to low, was Earthquake, Scour, Vehicular load. • Soil quality's effect was greater than scour depth on shallow foundation bridge's response. • 3D Finite-element modeling of scoured shallow foundation bridges was presented. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to understand the experiences of nurse managers during the COVID‐19 pandemic. Background: There is a growing body of knowledge about the experiences of clinical nurses during COVID‐19. However, there is less evidence about the experiences of nurse managers during the pandemic. Methods: Eight nurse managers, from acute care and outpatient settings, completed semistructured interviews about how their roles had changed during the pandemic, how they felt about these changes, and what had gone well or been difficult. Each participant was interviewed once, for 20–60 min. We used thematic analysis methods to analyse the interview transcripts. Findings Nurse managers had to coordinate care in a context of uncertainty and guidance that changed frequently. Participants found that their roles and responsibilities either expanded to include more duties, or they were asked to take on a completely new role, with no orientation or training. Nurse managers were expected to provide support to their staff and patients, but did not necessarily receive support themselves. Participants were expected to plan simultaneously for care during the pandemic and for a return to normal working conditions. These factors contributed to challenging and difficult participant experiences of managing during COVID‐19. Conclusion: Nurse managers' experiences during COVID‐19 are influenced by changes to their roles and the support they received. Nurse managers continue to support high‐quality care despite working a difficult context. Implications for nursing management: Where possible, nurse managers can be supported to extend their roles or receive additional education and support if they are required to take on new responsibilities. Nurse managers require support in order to be a resource for their staff. [ABSTRACT FROM AUTHOR]

UNIQUE PREPARATIONS FOR POTENTIAL BLOOD SHORTAGES DURING THE COVID-19 PANDEMIC A summary of RBC and platelet supply and demand determinants during the COVID-19 pandemic is shown in Figure 1. The sentinel implementation element of the Plan is the potential to convene the National Emergency Blood Management Committee (NEBMC), a congress of approximately 50 people, consisting of NAC members, provincial and territorial government official, and leadership from CBS medical, supply chain, and government relations groups (see Appendix S1 for the NEBMC Terms of Reference). Keywords: blood inventory; blood operator; blood shortage; COVID-19; pandemic response; transfusion service EN blood inventory blood operator blood shortage COVID-19 pandemic response transfusion service 3258 3266 9 11/05/21 20211101 NES 211101 Abbreviations ADRD Average Daily Red Cell Demand CBS Canadian Blood Services DoH Days on Hand IVIG intravenous immune globulin NAC National Advisory Committee on Blood and Blood Products NEBMC National Emergency Blood Management Committee PEBMC Provincial Emergency Blood Management Committee PPRP plasma protein and related products P/T provincial and territorial RBC red blood cell INTRODUCTION Security of supply is a priority for the blood system and must include consideration of inventory held by the manufacturer and held and utilized by hospital transfusion laboratories. Blood shortages planning in Canada: The National Emergency Blood Management Committee experience during the first 6 months of the COVID-19 pandemic. [Extracted from the article]

Objectives: Mass Casualty Incidents (MCIs) are rare but devastating events that require extensive planning in order to minimize morbidity and mortality. There are two broad categories limiting a hospital's response: physical assets (e.g., critical care beds, operating rooms, food, communication devices) as well as operating procedures (e.g., MCI committees, regional coordination, provider training). The purpose of this study is to provide an examination of MCI preparedness according to these categories in Level 1 Trauma Centre across Canada.Methods: This study surveyed all Level 1 Trauma Centres across Canada in order to assess the physical assets and operating procedures they had in place in the event of a hypothetical MCI on one of the busiest days of the year for trauma care.Results: Of the 28 Trauma Centres contacted, 13 completed surveys (46%). Most hospitals had sufficient food (9/13) water (9/13), fuel (7/13), and communication assets (8/13) for a hypothetical MCI. A median of 38 mechanical ventilators could be mobilized. No hospitals mandated physician training for MCIs, and 6/13 centres were certain that they had a Strategic Emergency Management Plan (SEMP). Only 6/13 hospitals had dedicated MCI committees, Overall, 4/13 hospitals had explicit plans developed with community hospitals.Conclusion: This study demonstrated that physical assets are generally less limiting than operating procedures. Four key areas of potential improvement have been identified: 1) provider training (especially physicians), 2) coordination with small hospitals, 3) mechanical ventilator availability, and 4) MCI committees with explicit Strategic Emergency Management Plans. [ABSTRACT FROM AUTHOR]

The degree to which exercises improve the collaboration among different organizations during an emergency is under debate. This study aims to contribute to the scarce research on this topic by giving insight into the perceived effects of exercises on collaboration, learning, usefulness and interorganizational trust. In particular, this quantitative study looked into the differences between the effects of tabletop and full‐scale exercises. A questionnaire assessing collaboration, learning, usefulness and trust—the CLUT instrument—was developed. Data were collected from 173 full‐time emergency management personnel in Norway and Canada. Usefulness, learning and collaboration outcomes were perceived to be high for both types of exercises, but full‐scale exercises were perceived to have greater learning and usefulness outcomes than tabletop exercises. Stronger relationships were identified between the perceived effects on learning and usefulness, collaboration and trust in tabletop compared to full‐scale exercise, whereas the relationship between the perceived effects upon collaboration and trust was stronger in full‐scale exercises. Multiple regression analysis showed that the variables used to measure exercise usefulness can better predict tabletop exercise outcomes. [ABSTRACT FROM AUTHOR]

Perceived (socio-cognitive) capacity is as important as objective (material resources) capacity in assessing the overall adaptive capacity of people at the community level. Higher perceived and objective capacities generate greater total adaptive capacity. This article assesses the perceived adaptive capacity of the Kashechewan First Nation, located in the flood-prone southwestern James Bay (Subarctic) region in Canada. The community is frequently disrupted by the elevated risk of spring flooding and has experienced five major floods since its establishment in 1957. Residents have been evacuated 14 times since 2004 because of actual flooding or flooding risk and potential dike failure. We surveyed 90 residents using 21 indicators to assess the community's perceived adaptive capacity. The results indicate that residents' risk perception and perceived adaptive capacity are high and are reshaping their adaptive behavior to the hazard of spring flooding. The strong positive interrelationships between human capital, social capital, governance, and other determinants, such as migration, personal resilience, and experience, also suggest high perceived adaptive capacity. Human capital and the other determinants are relatively higher contributors to the perceived adaptive capacity, followed by social capital and governance determinants. The results also indicate that residents' disaster preparedness has also improved. The elevated flooding risk and frequently occurring emergencies have motivated the First Nation to modify their spontaneous and proactive adaptation responses for disaster risk reduction at the individual, household, and band levels. Planning to adapt to natural hazards to mitigate their impacts also requires a nuanced understanding of the perceived adaptive capacity that contributes to overall adaptive capacity. Translating the high perceived adaptive capacity into greater total adaptive capacity would contribute to enhancing community resilience. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss the intrinsic social dilemmas that emerged during the COVID-19 pandemic and pandemic planning, as well as the invisibility of the personal support workers (PSW) despite the key role they play in healthcare systems. Also cited are the gendered dynamics of risks that were seen during the pandemic, and how the pandemic showed the limits of biomedicine and the fragility of the for-profit healthcare systems.

This article analyzes discourses of preparedness and public safety in the context of the colonial history of emergency measures in Canada. An argument is made for how current measures of pandemic preparedness produce the social responsibilization of public health. [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]

Objective: The aim of this study was to explore whether a relationship exists between the number of disasters a jurisdiction has experienced and the presence of disaster-specific pharmacy legislation. Methods: Pharmacy legislation specific to disasters was reviewed for five countries: Australia, Canada, UK, US and New Zealand. A binary logistic regression test using a generalised estimating equation was used to examine the association between the number of disasters experienced by a state, province, territory or country and whether they had disaster-specific pharmacy legislation. Results: Three of six models were statistically significant, suggesting that the odds of a jurisdiction having disaster-specific pharmacy legislation increased as the number of disasters increased for the period 2007–17 and 2013–17. There was an association between the everyday emergency supply legislation and the presence of the extended disaster-specific emergency supply legislation AH19093_IE1.gif. Conclusions: It is evident from this review that there are inconsistencies as to the level of assistance pharmacists can provide during times of crisis depending on their jurisdiction and location of practice. It is not a question of whether pharmacists have the skills and capabilities to assist, but rather what legislative barriers are preventing them from being able to contribute further to the disaster healthcare team. What is known about the topic?: The contributing factors to disaster-specific pharmacy legislation has not previously been explored in Australia. It can be postulated that the number of disasters experienced by a jurisdiction increases the likelihood of governments introducing disaster-specific pharmacy legislation based on other countries. What does this paper add?: This study compared five countries and their pharmacy legislation specific to disasters. It identified that as the number of disasters increases, the odds of a jurisdiction having disaster-specific emergency supply or disaster relocation or mobile pharmacy legislation increases. However, this is likely to be only one of many factors affecting the political decisions of when and what legislation is passed in relation to pharmacists' roles in disasters. What are the implications for practitioners?: Pharmacists are well situated in the community to be of assistance during disasters. However, their ability to help patients with chronic disease management or providing necessary vaccinations in disasters is limited by the legislation in their jurisdiction. Releasing pharmacists' full potential in disasters could alleviate the burden of low-acuity patients on other healthcare services. This could subsequently free up other healthcare professionals to treat high-acuity patients and emergencies. [ABSTRACT FROM AUTHOR]

COVID-19 a new infections agent took the world by surprise. Governments, medical systems, communities, and individuals soon would become familiar with many new terms and many new prevention measurements to avoid infection. To this day, it is unknown what would be the final consequences and impact in populations in the world, how those came to be a "new normal" in our daily lives. Also, it is unknown the number of victims, and economical after-effects result from the new pandemic. This article aims to establish a para parallel in relation to the early days of HIV/AIDS in the world. Keeping in mind the slow governmental, and even irresponsible response in different countries, both cases (HIV/AIDS-COVID-19), present a dimension that shows intermediately from HIV/AIDS organizations response to help communities. The article argues that is precise because we have learned as marginalized communities that reacted at the beginning of the AIDS early days, that HIV/AIDS educators adapted very fast interventions, programs, and counseling to alleviate societal effect pandemic against COVID-19 new infections. [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]

This paper presents a review of historical and latest insights into rock fall hazard temporal variability associated with weather. Reviewed research expands several locations around the world; however, focus has been on the recent advances in western Canada and from the author's experience. The recent research reviewed has provided new insights into the relationships between weather and rock fall occurrences and the recent focus on probabilistic approaches appears to be the way forward for rock fall hazard management. This paper also references some statistical tools for quantification of weather–rock fall relationships that allows better understanding of the stochastic nature of the phenomena. A decisive strength of how these methodologies are developing lies in the fact that adoption of probabilistic tools allows direct translation into rock fall hazard quantification that reflects its temporal variability. When coupled with weather forecasting, these tools can provide real-time forecasting of rock fall hazard. Moreover, some of these tools provide a way forward for forecasting the effects of climate change on rock fall hazards. [ABSTRACT FROM AUTHOR]

Managing oncologic emergencies is a fundamental competency for radiation oncology trainees and is evaluated through an entrustable professional activity (EPA) in the competency-by-design curriculum. Simulation-based learning has been extensively studied in medical education as an effective learning strategy to support achieving specific clinical skill goals. This study aims to evaluate the effectiveness of virtual cases in improving trainee knowledge and readiness to assess oncologic emergencies. Three virtual patient modules simulating common oncologic emergencies encountered throughout residency training in radiation oncology were developed using a simulation-based online learning platform. These modules include spinal cord compression, superior vena cava syndrome, and tumor-induced hemorrhage. Clinical vignettes were designed to mimic the clinical presentation and evolution of a patient exhibiting signs and symptoms of these common oncologic emergencies. Each module consisted of pre- and post-module questions compared to assess immediate knowledge acquisition. Questions focused on physical examination, imaging interpretation, staging, anatomy, epidemiology, differential diagnosis, prognostication, radiation planning, communication skills, and pertinent literature. We recruited radiation oncology residents from across Canada to participate over a 6-month period from June to December 2021. A total of 13 radiation oncology trainees across Canada (PGY2-6) completed 32 virtual patient scenarios. The modules were completed by junior residents (PGY2-3) 24 times and by senior residents (PGY4-6) 8 times. For all residents, the mean pre-module completion score was 66% (range 60-71%). Mean pre-module completion scores were 65% (range 63-68%) and 69% (range 50-80%) for junior and senior residents, respectively. Mean post-module completion scores were higher, at 92% (range 89-95%) for all residents, 92% (range 90-94%) and 91% (range 88-95%) for junior and senior residents, respectively. Pre-module completion scores were lowest for the tumor-induced hemorrhage scenario, identifying a potential knowledge gap. Resident feedback was unanimously positive, and residents reported that these online modules were useful for their learning. Online virtual patient modules can be used as complementary learning and assessment tools in the management of different oncologic emergencies. There is a significant improvement in knowledge acquisition after completion of each module, and this improvement is seen across all years of residency. Overall, residents find this learning method useful. [ABSTRACT FROM AUTHOR]

Highlights • Just-in-time fuel inventories reduce resilience against fuel shortages. • Subduction earthquakes can cause widespread fuel shortages. • Localized fuel shortages after earthquakes are likely in the next 50 years. • A new object-oriented network model was developed to explore resilience scenarios. • Local emergency planners helped improve simulations and build realistic solutions. Abstract An agent-based object-oriented model for the fuel distribution network in coastal British Columbia in Canada is presented. Objects representing infrastructure components with varied attributes and behaviors are described together with objects representing transportation modes on land and on water. A novel feature of the modeling approach is its capacity to represent the diverse nature of the objects in a network. Another novelty of the approach is its capacity to simulate discrete deliveries based on requests, which is a requirement in the modeling of the considered fuel distribution network. This paper presents the software architecture and applies it to assess the probability of fuel shortages following an earthquake for six storage facilities in coastal British Columbia. The results of this assessment can be used to inform emergency response plans. [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]

How to improve coordination between formal and unaffiliated or spontaneous volunteers after emergencies is currently an international question with a high profile. Drawing on international disaster management literature and experiences and recent crisis events in Canada, our analysis examines four Canadian case studies to show that the inclusion of citizens in EM is becoming indispensable, as simultaneously as the frequency and intensity of natural disasters are seen to be growing due to climate change, and citizens are increasingly presenting their labour and resources as assets to be drawn on in emergency and postemergency situations. In this context, Canadian municipalities are starting to better manage the unpredictability of spontaneous citizen volunteering in emergencies by building anticipatory structures of networked governance for integrating diverse, pre‐existing, and in some cases, pre‐identified groups of citizens as volunteers in emergency management functions. Additionally, as the role of voluntary service organizations is becoming elevated in emergency response and recovery in Canada, these organizations can prospectively play the role of brokers to help emergency management agencies access and manage community‐based networks of voluntary resources. [ABSTRACT FROM AUTHOR]

This is an institutional study of the policy instruments that respond to flood for agricultural producers and their community. Two case studies in Saskatchewan and Alberta, Canada were conducted through a review of secondary sources and semi-structured qualitative interviews to assess instruments based on the perceptions of agricultural producers and people involved in flood governance. Recent changes reducing federal government emergency training services for local responders have occurred at the same time that federal government disaster assistance payments to provinces and local communities have increased dramatically. Financial instruments are of key importance but increased attention should be paid to management instruments including participatory resilient emergency flood planning. Fragmentation in flood instruments and planning, together with a myopic time frame that does not include climate change considerations, leaves the study communities and agricultural producers vulnerable. Disparate communities not operating cohesively as districts leave one case study area vulnerable. These deficiencies are remediable by implementing appropriate missing instruments and comprehensive institutional flood planning. [ABSTRACT FROM AUTHOR]

The article offers the author's perspective, as a Canadian, on disaster capitalism. The author says that foreign aid is one of the instruments of the nation's foreign policy, but voters seldom contemplate capitalism's priorities when they decide how to vote. He adds that Canadians are entitled to derive benefits from such aid. He also argues against the idea of reshaping such policy to prioritize capitalism's interests abroad.

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]

Following an earthquake, urban agriculture has been shown to improve recovery by increasing food security and providing numerous community and social benefits. However, many communities often do not consider urban agriculture within their earthquake or disaster preparedness programs. This work explores the intersection between those two realms, considering how their integration may increase food security and improve resilience following an earthquake. Through a case study focusing on the City of Vancouver, British Columbia, Canada, this research involved a four-step strategic scan of planning and earthquake management documents to determine whether Vancouver has captured the benefit of urban agriculture for earthquake recovery. Results revealed that this benefit has yet to be realized, however there is ample opportunity to do so given the City's advances in urban agriculture. This research seeks to provide planners, city officials and emergency management with insight into the potential of urban agriculture for earthquake preparedness. More broadly, this work seeks to add to the discussion by exploring a tangible integration of two realms that are often planned in isolation, yet could have positive impacts if combined. This paper concludes with specific interventions for how urban agriculture can be utilized for earthquake recovery in order to build resilience. • Food security and malnutrition are pervasive issues following an earthquake. • Urban agriculture can improve food security during earthquake recovery. • Urban agriculture provides social and community benefits during recovery. • Earthquake-prone areas should consider urban agriculture in preparedness programs. • Considering urban agriculture within earthquake management can increase resilience. [ABSTRACT FROM AUTHOR]

Understanding wildfire impacts on structures in wildland urban interface (WUI) communities is fundamental for emergency response and mitigation planning to reduce potential social and economic losses. The magnitude of structures loss determines the direct economic costs for re-building, indirect economic losses due to evacuation and disruption of economic activities as well as shelter needs. This paper presents a framework for the development and implementation of incident-level wildfire impact assessment of WUI residential structures including the following successive components: hazard, inventory, exposure, and impact. The hazard model generates spatial and temporal distribution of fire intensity for wildfire event scenarios; the inventory model provides spatial pattern of exposed structures; the exposure model estimates the fire intensity at WUI locations; whereas the impact model evaluates the structures loss by applying newly developed empirical response functions represented as the relationship between fire intensity, distance from forest edge and expected proportion of burned structures. A case study application of the proposed framework is presented for loss assessment of structures in a WUI community of the northern boreal forest of Canada. The proposed framework is particularly useful to the public safety community for conducting what-if scenarios of wildfire impact in support of emergency and mitigation planning. [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]

This paper takes an anthropological approach to understanding the governance of seaport security in Canada; it uses cultural theory and the concepts of regulation and integration as key determinants in understanding how organizations respond to risk. This paper draws on data from 29 semi-structured interviews with transportation specialists, including owners, operators, managers and regulators. Nine of the interview subjects came from seaports, in particular. The interviews occurred between 2011 and 2013. We argue that Canadian seaports exist in an area of confusing multi-level governance; they are immovable, are expected to be competitive and serve a number of (at times competing) public and private sector interests. These institutional arrangements have resulted in a security environment that is heavily regulated, but the community itself is not well integrated. Interview subjects raise concerns about the ports' ability to respond to security threats. The paper then uses cultural theory to examine alternative governance arrangements enhancing, for example, community, competition or regulation. While most options to improve security will likely reduce the competitiveness of the seaports, it would help to instill more confidence among port staff and enhance organizational learning. [ABSTRACT FROM AUTHOR]

Aim The aim of this paper was to provide a concept analysis of 'pandemic influenza'. Background Pandemic influenza can have a devastating impact as individuals have little to no immunity towards the newly encountered virus. It is a persistent societal threat due to the advancement of multiple technological processes. Nurses work in multiple roles in pandemics. As such, a thorough understanding of the concept and its implications from a nursing perspective is required. Design Rodgers' Evolutionary Method was used to conduct the concept analysis of the term 'pandemic influenza'. Data sources Forty-nine papers were examined from the disciplines of public health, medicine, law, bioethics and healthcare policy. Papers were found from the PubMed, CINAHL and Google Scholar databases all dates up to December 2013. Limits were set to include peer-reviewed, English language articles. Methods Identified papers were critically analyzed to explore the concept's antecedents, attributes and consequences. Surrogate and related terms, and an exemplar, were identified. Results Attributes of pandemic include original viral structure, increased human susceptibility, younger vulnerable populations and unpredictable time frames. Antecedents include processes that enable the increased geographical transmission of a newly created influenza. Consequences include higher morbidity and mortality rates and the need for an efficient pandemic response. Conclusions This analysis identified the attributes of pandemic influenza through a synthesis of the current pandemic literature. However, no articles were identified as specifically nursing in nature. Therefore, more research is required to examine the impact of a pandemic declaration on the nursing profession. [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]