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Objective: With the increase in natural disasters and the expected role of public health nurses (PHNs) in responding, it is crucial to develop evidence-based disaster preparedness and management training programs tailored to the needs of PHNs. This study evaluates the effectiveness of a flipped classroom approach in disaster training for PHNs., Methods: A total of 42 PHNs completed a 5-hour online training program and an in-person 8-hour training session at a local nursing school. Surveys measuring self-reported confidence and knowledge were completed at the beginning and end of the online and in-person training., Results: The average years of experience as an RN and PHN were 12.3 years and 6.7 years, respectively. Approximately 64% of participants had never deployed during a disaster. The pre- and posttest demonstrated a large effect size, indicating the effectiveness of both online and in-person training. The online training resulted in significant changes in knowledge. The in-person training showed a statistically significant increase in confidence across all measures., Conclusions: Online and in-person disaster preparedness training programs can effectively enhance the knowledge, skills, and attitudes of PHNs. The majority of participants expressed that the training better prepared them to work in disaster shelters.

In recent history, outbreaks of high-consequence infectious diseases (HCIDs) have raised health security concerns among the global community. As HCIDs continue to emerge, public health systems around the world experience the burden of implementing adequate preparedness and response measures to ensure the safety and security of their populations. HCID outbreak response efforts have highlighted the need for specialized training in safety and infection prevention and control for frontline workers who may encounter ill patients. The COVID-19 Mission Prep program for National Disaster Medical System personnel and the Deployment Safety Academy for Field Experiences (D-SAFE) program for US Public Health Service officers are 2 examples of virtual training programs that successfully provided foundational education on infection prevention and control and safety as well as deployable just-in-time training during HCID outbreak response efforts. The methods used to develop these training programs can be adopted by other countries to enhance the global outbreak response infrastructure for the next HCID event. The global outbreak response infrastructure demands investments in training as a preparedness measure, which will ultimately lead to safer, more coordinated outbreak response efforts with competent responders.

The current security situation, both in terms of domestic and foreign politics, continues to pose a major challenge for Germany and it is therefore important to prepare the healthcare system for this. In the context of catastrophes based, e.g., on violence, terror, crisis or war, it will be unavoidable to have to treat a large number of injured and wounded casualties. The need for surgical treatment will always play a central role in this context, so that it is imperative that our hospitals and clinics are prepared in this respect. In addition to the general training content in a clinical context, there is a particular need for content that addresses nonroutine aspects, such as gunshot and blast injuries and also provides organizational and strategic recommendations for action. The Academy of Trauma Surgery (AUC) of the German Society for Trauma Surgery is a central and important partner for the German healthcare system and shows how such content, also based on structural advantages such as the TraumaNetworks DGU®, can be successfully communicated., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: M. Blätzinger ist Geschäftsführer der Akademie der Unfallchirurgie - AUC DGU. A. Franke ist ATLS-Kursdirektor und -instruktor, Nationaler Kursdirektor TDSC, TDSC-Kursdirektor und -instruktor, Ltr. Sektion EKTC der DGU, Mitglied Sektion NIS der DGU, Stellv. Leiter AK Traumaregister der DGU. B. Friemert ist TDSC-Kursdirektor und –instruktor. D. Bieler ist ATLS-Kursdirektor und -instruktor, TDSC-Kursdirektor und -instruktor, Mitglied Sektion EKTC der DGU, Ltr. Sektion NIS der DGU. P. Hube ist Mitglied der Sektion EKTC der DGU. G. Achatz ist TDSC-Kursdirektor und -instruktor, Stellv. Ltr. Sektion EKTC der DGU, Mitglied Sektion NIS der DGU, Deputy-Head Disaster & Military Section ESTES. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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Emergency preparedness initiatives are a Medicare condition of participation in home healthcare, yet limited evidence on the impact of associated programming is available. The purpose of this exploratory pilot study was to examine the outcomes of an individualized emergency preparedness educational program provided by a physical therapist (PT) in the homes of older adults. The investigators recruited older adults (n = 30) using convenience sampling. An emergency preparedness education module was developed. Demographics, functional and environmental outcome measures, a pre- and post-education confidence survey, and learning outcomes were ascertained and analyzed. Participants reported being female (n = 23), 70 to 79 years (n = 15), and 19 individuals reported 35 different lifetime emergency events. Hearing and vision impairments, inability to change a battery or navigate stairs, and environmental deficits including clutter and poor lighting were identified. Closing bedroom doors at nighttime, functioning carbon monoxide and smoke detectors, creating an evacuation plan, and assembling first aid kits were learning outcomes. Trends toward increased confidence were identified, with statistically significant improvements in the ability to respond to a fire (P = .01), a heat wave (P = .03), and to crawl on hands and knees (P = .05) identified. This study provides emerging evidence that PTs have a role in improving an older adult's confidence to prepare for and respond to an emergency event., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Considering recent earthquakes and the COVID-19 pandemic, disaster preparedness has come to the forefront of the public health agenda in Nepal. To strengthen the developing health system, many initiatives are being implemented at different levels of society to build resiliency, one of which is through training and education. The first International Conference on Disaster Preparedness and Management convened in Dhulikhel, Nepal on December 1-3, 2023. It brought together international teaching faculty to help deliver didactic and simulation-based sessions on various topics pertaining to disaster preparedness and management for over 140 Nepali healthcare professionals. This paper focuses on the tabletop exercise-based longitudinal workshop portion of the conference on disaster leadership and communication, delivered by United States-based faculty. It delves into the educational program and curriculum, delivery method, Nepali organizer and US facilitator reflections, and provides recommendations for such future conferences, and adaptation to other settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pandya, Kharel, McMahon, Basnet, Soghoian, Pradhan and Arquilla.)

The global experience with COVID-19 holds important lessons for preparing for, and responding to, future emergences of pathogens with pandemic potential., Competing Interests: Potential conflicts of interest. Both authors: No reported conflicts. Both authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Training healthcare workers in disaster preparedness has been shown to increase their willingness and ability to report to work during disasters. Little is known, however, about the relation between sociodemographic, household, and workforce characteristics and the desire for such training. Accordingly, this study aimed to assess healthcare workers' desire for additional workforce preparedness training, and the determinants that influence the need for such training, for three types of disasters (natural, pandemic, manmade)., Methods: The US Department of Veterans Affairs (VA) Preparedness Survey was a random, anonymous, Web-based questionnaire fielded nationwide (October-December 2018). Multivariate, logistic regression analyses were conducted., Results: In total, 4026 VA employees, clinical and nonclinical, responded. A total of 61% of respondents wanted additional training for natural, 63% for pandemic, and 68% for manmade disasters. VA supervisors (natural: odds ratio [OR] 1.28, pandemic: OR 1.33, manmade: OR 1.25, P < 0.05) and clinicians (natural: OR 1.24, pandemic: OR 1.24, manmade: OR 1.24, P < 0.05) were more likely to report the need for additional training. Those who reported that they understood their role in disaster response were less likely to report the need for training (natural: OR 0.25, pandemic: OR 0.27, manmade: OR 0.28, P < 0.001), whereas those who perceived their role to be important during response (natural: OR 2.20, pandemic: OR 2.78, manmade: OR 3.13, P < 0.001), and those who reported not being prepared at home for major disasters (natural: OR 1.85, pandemic: OR 1.92, manmade: OR 1.94, P < 0.001), were more likely to indicate a need for training., Conclusions: Identifying which factors encourage participation in disaster preparedness training can help hospitals and other healthcare providers create targeted training and educational materials to better prepare all hospital staff for future disasters.

The British Army has a long history of training in Kenya, including delivering health outreach to the local population on Exercise ASKARI SERPENT. This article presents data from two iterations of Exercise ASKARI SERPENT in which children accounted for almost 40% of all patients treated. Short case vignettes highlight the technical and non-technical challenges faced when treating children, before recommendations are made for pre-deployment training for Exercise ASKARI SERPENT and similar future deployments which may see military clinicians delivering treatment to the local population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

This manuscript reviews the importance of disaster preparedness for the social services and public services professional. The value in separating fact from fiction in regard to probabilities for biological, chemical, and nuclear terrorism is highlighted. The various phases of disaster preparedness are elucidated along with the components of the effective all-hazards plan. Consideration of the psychological impact of disasters is presented in conjunction with the role of the mental health worker in the amelioration of outcomes. The role of electronic technology in disaster preparedness is elaborated, and useful websites are cited to facilitate disaster planning.

Introduction: Leadership and crisis resource management (CRM) skills are important skills for doctors, however there is a recognised lack of undergraduate leadership education. There remains debate over how best to teach leadership and CRM skills, and poor leadership skills among clinicians are associated with adverse patient outcomes. We examined whether high-fidelity battlefield and prehospital scenarios can improve leadership and CRM skills., Method: This was a prospective observational study with students self-reporting their leadership and CRM skills using the Ottawa Crisis Resource Management Global Ranking Scale (OCRMGRS) before and after completing the Cambridge University Emergency Medicine Society Battlefield and Pre-Hospital Trauma course. The course involves a mixture of small group tutorials and practical high-fidelity battlefield and prehospital trauma scenarios. Faculty also completed the OCRMGRS for the first and last candidates at the scenarios. The mean precourse versus mean postcourse score of the OCRMGRS was analysed using a two-tailed t-test., Results: 46 students completed paired OCRMGRS before and after the course. The mean precourse scores for each of the domains (leadership, communication skills, resource utilisation, problem solving skills and situational awareness) were calculated. There was a statistically significant (p<0.05) increase in both self-reported and faculty-reported scores across all domains, and the increase remained at 1-year follow-up., Conclusions: Leadership and CRM skills are important non-clinical skills for doctors, however there is debate over how best to teach them. High-fidelity battlefield and prehospital trauma scenarios are an effective means of teaching leadership and CRM skills to civilian medical students., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

In a wide range of events, people may be acutely exposured to chemical substances. Particular hospital preparedness plans and vital resources are essential for appropriate health-care measures. The present study aimed to conduct a systematic review to summarize and evaluate the existing evidence on hospital preparedness plans or protocols against chemical incidents and threats. In this aim, through May 15, 2018, 5 electronic databases were searched in MEDLINE (PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar) for the following key words: hospital preparedness, plan, protocol, chemical incident, and chemical threat. The final review included 11 peer-reviewed papers that met inclusion criteria. The systematic review was performed using the Preferred Reporting Items for the Systematic reviews and Meta-Analysis protocol (PRISMA) (www.prisma-statement.org). Finally, of 16,540 selected papers, 11 papers were included in the final analysis. The thematic analyses revealed 11 major categories of chemical incidents and threats planning, such as planning requirements, planning prerequisites, preparation team member (multidisciplinary team), decontamination, personal protective equipment, education and training, job descriptions and roles, communication, database, staff /volunteer organization, as well as planning barriers and challenges for chemical incidents. Most countries have launched hospital preparedness planning against chemical incidents and threat activities, but the preparedness of hospitals is often less than desirable. Many items, such as databases, hospital preparation team members, communications, etc., are still challenging.

Objective: Natural disasters are becoming increasingly common, but it is unclear whether families can comprehend and use available resources to prepare for such emergencies. The objective of this study was to evaluate the literacy demands of risk communication materials on natural disasters for US families with children., Methods: In January 2018, we assessed 386 online self-directed learning resources related to emergency preparedness for natural disasters using 5 literacy assessment tools. Assessment scores were compared by information source, audience type, and disaster type., Results: One-in-three websites represented government institutions, and 3/4 were written for a general audience. Nearly 1-in-5 websites did not specify a disaster type. Assessment scores suggest a mismatch between the general population's literacy levels and literacy demands of materials in the areas of readability, complexity, suitability, web usability, and overall audience appropriateness. Materials required more years of education beyond the grade level recommended by prominent health organizations. Resources for caregivers of children generally and children with special health care needs possessed lower literacy demands than materials overall, for most assessment tools., Conclusions: Risk communication and public health agencies could better align the literacy demands of emergency preparedness materials with the literacy capabilities of the general public.

Objective: The Centers for Disease Control and Prevention developed 15 National Public Health Emergency and Preparedness Response Capabilities (NPHPRCs) to serve as national standards for health-related core capabilities. The objective of this study is to determine the level of federal funding allocated for research related to NPHPRCs during 2008-2017., Methods: An online search of http://www.USAspending.gov was performed to identify federal awards, grants, contracts from 2008-2017 related to research associated with NPHPRCs. Inclusion criteria were identifiable as research and disaster-related; US-based; and specific reference to any of the NPHPRCs. A panel of 3 experts reviewed each entry for inclusion., Results: The search identified 15 278 transactions representing US $29.2 billion in awards. After exclusions, 93 entries were found to be related to NPHPRCs, averaging US $2 783 136 annually. Funding notably dropped to US $168 684 in 2010 and ceased entirely in 2016. Ten (67%) of NPHPRCs received funding. Eighty-percent of funding focused on 4 capabilities. Three federal agencies funded 80% of research. Sixteen (24%) of the 47 recipients received 80% of all funding., Conclusion: US federal investments in research and development related to NPHPRCs have been highly variable over the past decade. One-third of NPHPRCs receive no funding. There are notable gaps in funding, content, continuity, and scope of participation.

Background and Purpose: Educational escape rooms assist students with the development of teamwork, augmentation of problem-solving skills, and reinforcement of key course concepts. In this report, we examined the feasibility of creating a bioterror preparedness escape room in a small enrollment pharmacy public health elective course., Educational Activity and Setting: A bioterror preparedness escape room was developed for pharmacy students in a health elective course. The instructional objectives of training students in disaster preparedness were assessed via group readiness assessment tests in the scenario and individual readiness assessment tests after the completion of the activity., Findings: Twenty-eight students participated in the escape room activity in groups of 6 to 8 students (n = 4 observations) and all groups escaped. Student performance was higher on the initial attempts of three group readiness assessment tests (88 ± 16.0%, 82 ± 7.1%, 78 ± 12.0%) than in the final individual readiness assessment test (73.4 ± 20.4%). Students indicated that they found the educational escape room to be enjoyable (95.7%) and felt that all members of the team were involved in solving the problems (86.9%)., Summary: A disaster preparedness educational escape room was designed and implemented in a public health elective for pharmacy students. Findings indicate that the educational escape room format is an effective method for reinforcing course content, however additional improvements could be made to the instructional design to enhance individual student knowledge retention., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

This study aimed to identify the factors affecting home-based disaster preparedness among Korean parents of school-aged children, based on an ecological model. A descriptive study was conducted involving 233 parents with school-aged children, using an online survey questionnaire. Parents' home-based disaster preparedness scores were classified into four groups: not prepared (36.5%), minimally prepared (38.2%), better prepared (17.6%), and most prepared (7.7%). Home-based disaster preparedness predictors corresponded to occupation and disaster-related knowledge in Model I, parents who had received disaster education in Model II, and age and participation in disaster education for parents and children together in Model III. The findings indicate that home-based disaster preparedness in Korea is inadequate. Therefore, it is necessary to develop and provide disaster-related education programs that consider each population group's needs and disaster preparedness level. Additionally, it is important to form networks for sharing the latest disaster-related information both inside and outside the family to maintain and manage disaster preparedness at home., (© 2020 John Wiley & Sons Australia, Ltd.)

Background: Recent infectious disease outbreaks highlight the importance of competent professionals with expertise on public health preparedness and response at airports. The availability of a competency profile for this workforce supports efficient education and training. Although competency profiles for infectious disease control professionals are available, none addresses the complex airport environment. Therefore, the main aim of this study is to develop a competency profile for professionals involved in infectious disease preparedness and response at airports in order to stimulate and direct further education and training., Methods: We developed the competency profile through the following steps: 1) extraction of competencies from relevant literature, 2) assessment of the profile in a national RAND modified Delphi study with an interdisciplinary expert group (n = 9) and 3) assessment of the profile in an international RAND modified Delphi study with an airport infectious disease management panel of ten European countries (n = 10)., Results: We systematically studied two competency profiles on infectious disease control and three air transport guidelines on event management, and extracted 61 relevant competencies for airports. The two RAND modified Delphi procedures further refined the profile, mainly by specifying a competency's target group, the organizational level it should be present on, and the exact actions that should be mastered. The final profile, consisting of 59 competencies, covers the whole process from infectious disease preparedness, through the response phase and the recovery at airports., Conclusion: We designed a profile to support training and exercising the multidisciplinary group of professionals in infectious disease management in the airport setting, and which is ready for use in practice. The many adaptations and adjustments that were needed to develop this profile out of existing profiles and air transport guidelines suggest that other setting-specific profiles in infectious disease control are desirable., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Earthquakes, landslides, and floods are the most frequent natural disasters in Turkey. The country has also recently experienced an increased number of terrorist attacks. The purpose of this study is to understand the expectations and training of Turkish emergency medicine attending physicians in disaster medicine., Methods: An online questionnaire was administered to the 937 members of the Emergency Medicine Association of Turkey, of which 191 completed the survey (20%)., Results: Most participants (68%) worked at a Training and Research Hospital (TRH) or a University Hospital (UH), and 69% had practiced as an attending for 5 years or less. Mass immigration, refugee problems, and war/terror attacks were considered to be the highest perceived risk topics. Most (95%) agreed that disaster medicine trainings should occur during residency training. Regular disaster drills and exercises and weekly or monthly trainings were the most preferred educational modalities. Most respondents (85%) were interested in advanced training in disaster medicine, and this was highest for those working less than 5 years as an attending. UH and TRH residency training programs were not considered in themselves to be sufficient for learning disaster medicine., Conclusions: Turkish emergency medicine residency training should include more disaster medicine education and training.

The integration of external staff into a hospital's disaster response can present technical challenges. Although hospitals will always prefer to use their own staff in disaster response, there have been many historical examples where external staffing is required. During the 2016 Kumamoto Earthquakes, the Oita Prefectural Hospital required medical professionals to expand disaster response staff. They were able to identify 2 appropriate emergency physicians belonging to a remote hospital who had previously worked at the Oita Prefectural hospital. The physicians were effectively able to supplement the hospital staff, providing care for additional patients, and giving the existing on-duty staff some respite. Based on our experience, we suggest that hospital coalitions and disaster response authorities explore mechanisms of cross-credentialing and cross-training staff to make it easier to share staff in a disaster.

Clinical decision support and e-learning will be essential if we are to achieve the goal of preventing outbreaks of infectious diseases caused by extremely dangerous pathogens. However, these resources on their own will not be enough to achieve this outcome. To achieve this outcome, resources must be integrated into undergraduate and postgraduate educational curricula, accredited as part of continuous professional development programmes, built around the knowledge and skills gaps of learners and developed using an evidence-based methodology that will enable healthcare professionals to put their learning into action for the benefit of both patients and populations. This article describes and contextualises the personal views discussed at a workshop on education and clinical decision support for healthcare professionals reacting to an infectious disease outbreak from extremely dangerous pathogens., Competing Interests: Competing interests: KW works for BMJ Learning and BMJ Best Practice which produce a range of resources in infectious and non-infectious diseases., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Natural disasters present unique challenges for healthcare training programs. Limited literature has been published regarding the impact of natural disasters on pharmacy residency training. The objective of this study was to determine the degree of perceived impact natural disasters have on pharmacy resident stress and which factors contribute to any perceived change in stress., Methods: A cross-sectional study was conducted via a survey distributed to pharmacy residents whose program was located in an area potentially affected by natural disaster in the first six months of the 2017-2018 resident year. A modified Likert scale utilizing a 10-point scale was used to assess resident stress. Potential sources of stress were assessed via multiple-choice questions. The primary outcome was the degree of change in resident perceived stress compared to baseline during and after the natural disaster., Results: One hundred twenty-nine pharmacy residents completed the survey. Stress increased from baseline during the natural disaster and remained elevated after compared to baseline. Main sources of stress were increased residency workload, natural disaster preparation and recovery, and concerns regarding friends and family. Half of residents reported their residency program did not have an established natural disaster policy in place., Conclusions: Improved planning and communication regarding workload expectations may minimize stress among residents balancing increased personal responsibilities during times of natural disaster., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier Inc. All rights reserved.)

All NHS Trusts face a diverse range of potential threats and disruptions that can overwhelm the delivery of their routine healthcare services. Major incidents range from significant infrastructure failure to responding to significant casualty numbers from natural disasters and malicious incidents. Major incident plans are one of the body of documents that support trusts and in this instance acute NHS trusts in emergency preparedness. Major incident plans can be used as a reference point for staff of all disciplines, that is, clinical and non-clinical. Major incident plans incorporate the requirements of the Civil Contingencies Act 2004 for NHS-funded providers to ensure trusts conduct risk assessments, emergency planning, cooperating with other organisations, and internal and external communication. This paper summarises some of the key aspects in the construction and the use of major incident plans in acute care trusts., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2020. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Major disease outbreaks continue to be a significant risk to public health, with pandemic influenza or an emerging infectious disease outbreak at the top of the UK National Risk Register. The risk of deliberate release of a biological agent is lower but remains possible and may only be recognised after casualties seek medical attention. In this context the emergency preparedness, resilience and response (EPRR) process protects the public from high consequence infectious diseases, other infectious disease outbreaks and biological agent release. The core elements of the EPRR response are recognition of an outbreak, isolation of patients, appropriate personal protective equipment for medical staff and actions to minimise further disease spread. The paper discusses how high-threat agents may be recognised by clinicians, the initial actions to be taken on presentation and how the public health system is notified and responds. It draws on the national pandemic influenza plans to describe the wider response to a major disease outbreak and discusses training requirements and the potential role of the military., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The necessity of disaster preparedness among nursing students has been continuously emphasized., Objectives: This study aimed to verify the effectiveness of a simulation-based education program for nursing students responding to mass casualty incidents (MCI) from the perspectives of triage accuracy, response attitude, teamwork, and program satisfaction., Design: This study employed a pre-post intervention design., Settings: Disaster Simulation Lab and a debriefing room in the University Nursing Simulation Center in South Korea., Participants: The participants were 34 graduating nursing students attending a university in Seoul., Methods: The program consisted of lectures on disaster nursing, group discussions, practice, debriefings, and a pre- and post-test, conducted over 180 min. Simulation-based training was conducted using the Emergo Train System®. The simulation environment comprised pre-hospital and hospital sections, with videos displayed on a large screen and sound effects played on loudspeakers., Results: Participants were likely to undertriage. There was a significant increase in positive attitudes after the intervention (p < .001). Self-reported teamwork was high, and among its subfactors, "leadership and team coordination" scored the highest. Participants' satisfaction with the program was high (4.5/5.0)., Conclusions: The simulation-based MCI program was effective in boosting positive attitudes among nursing students. In future, comparative studies including control groups and different instructional methods should be conducted. A patient bank should also be developed considering participants' knowledge levels and the circumstances of each country., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The National Health Service (NHS) England Emergency Preparedness, Resilience and Response Framework exists to provide a structure by which NHS England and NHS-funded bodies prepare for and respond to a range of emergencies. This framework exists to ensure that in emergencies the NHS retains the capability to deliver appropriate care to patients. Rather than dealing with individual scenarios, the framework aims to maintain the adaptability and capacity to deal with a variety of emergencies, their consequences and guide recovery plans. This paper summarises this guidance and elucidates the reasoning and mechanisms by which this care will be facilitated and delivered., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2020. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

As an organisation, locality or nation, there is a growing need to respond to a wide range of incidents and emergencies that could affect health and the care of patients. Responses to both domestic and international incidents have shown that collaboration, understanding and joint responses across organisations have improved the outcome of those affected by incidents which impact on health. Emergency response is something that is of increasing importance and has been tested on multiple occasions during recent events in the UK. Regarding health, the aim is to respond rapidly and efficiently, reducing potential morbidity and mortality to the lowest possible level in a given circumstance. This paper discusses what is meant by EPRR (Emergency, Preparedness, Resilience and Response), types of potential incidents, how we collectively prepare for responding and what has been learnt during recent events. It concludes with an outline of some selected current activity and highlights the likelihood of increased cross-sector working in EPRR., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2020. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Children are potential victims of chemical or biological terrorism. In recent years, children have been victims of terrorist acts such as the chemical attacks (2017-2018) in Syria. Consequently, it is necessary to prepare for and respond to the needs of children after a chemical or biological attack. A broad range of public health initiatives have occurred since the terrorist attacks of September 11, 2001. However, in many cases, these initiatives have not ensured the protection of children. Since 2001, public health preparedness has broadened to an all-hazards approach, in which response plans for terrorism are blended with those for unintentional disasters or outbreaks (eg, natural events such as earthquakes or pandemic influenza or man-made catastrophes such as a hazardous-materials spill). In response to new principles and programs that have evolved over the last decade, this technical report supports the accompanying update of the American Academy of Pediatrics 2006 policy statement "Chemical-Biological Terrorism and its Impact on Children." The roles of the pediatrician and public health agencies continue to evolve, and only their coordinated readiness and response efforts will ensure that the medical and mental health needs of children will be met successfully. In this document, we will address chemical and biological incidents. Radiation disasters are addressed separately., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Objectives: To improve access to quality online training materials developed from 2010 to 2015 by 14 Preparedness and Emergency Response Learning Centers (PERLCs) by creating quality standards and enhancing searchability through a new Web-based public health training catalog., Methods: The PERLC-developed training materials (n = 530) were evaluated for their capability to support development of preparedness competencies as established by 2 evidence-based competency frameworks. Inclusion/exclusion criteria and evaluation guidelines regarding training quality (design, technology, and instructional components) were systematically applied to PERLC products to create a training catalog. Twenty emergency preparedness professionals pilot tested content and provided feedback to improve catalog design and function., Results: Seventy-eight percent of PERLC resources (n = 413) met our quality standards for inclusion in the catalog's searchable database: 358 self-paced courses, 55 informational briefs, and other materials. Twenty-one training bundles were curated., Discussion: We established quality guidelines, identified strengths and weaknesses in PERLC resources, and improved accessibility to trainings. Guidelines established by this work can be generalized to trainings outside the preparedness domain. Enhancing access to quality training resources can serve as a valuable tool for increasing emergency preparedness competence.

Background: Simulation is an evidenced based strategy which has been shown to impact office-based readiness to respond in a medical emergency. Medical emergencies occur in the primary care setting on a less frequent basis than in the inpatient setting. Clinicians working in primary care may benefit from an opportunity to refresh their skills., Methods: This descriptive pre and post survey design evidenced based project examined staff reported levels of competence and confidence when responding to an emergency in a pediatric primary care office. Simulation educators partnered with ambulatory nursing and medical leaders to create a mock code program for staff in a care network. During a 14-month period, simulations were conducted in 30 primary care sites. Staff completed pre- and post-simulation surveys to assess levels of confidence in decision-making skills and competence when managing medical emergencies., Findings: A statistically significant increase in the mean scores for both confidence and competence was demonstrated when comparing pre- and post-simulation survey results., Discussion and Application to Practice: Simulation as an educational technique resulted in an increased level of competence and confidence of primary care office staff to respond to an emergency. Additionally, staff developed an overall heightened awareness of emergency processes and recognized of the value of simulation as an educational tool., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The aim of this study is to enrich public health emergency management (PHEM) curricula and increase the workforce readiness of graduates through the implementation of an innovative curriculum structure centered around simulation and the creation of authentic learning experiences into a mastery-based Disaster Preparedness graduate certificate program launched in 2016 at the Colorado School of Public Health. Learners progress through a sequence of increasingly complex discussion and operations-based exercises designed to align with training methodologies used by future employers in the disaster response field, covering PHEM fundamentals and domestic and international disaster preparedness and response. Preliminary feedback is overwhelmingly positive, equating the experience to securing an internship. Embedding simulation-based exercises and authentic learning environments into graduate curricula exposes learners to diverse disaster scenarios, provides occasion for practicing critical thinking and dynamic problem solving, increases familiarity with anticipated emergency situations, and builds the confidence necessary for exercising judgment in a real-world situation. This novel curriculum should serve as a model for graduate programs wishing to enrich traditional training tactics using a typical school of public health support and alignment with community resources. (Disaster Med Public Health Preparedness. 2019;13:777-781).

Pregnant women and children and individuals suffering from chronic illness are disproportionally impacted by public health emergencies. To meet the healthcare needs of these populations, the nursing workforce must be capable of responding in a timely and appropriate manner. The goal of this project was to create interactive and engaging evidence-based educational tool kits to advance healthcare provider readiness in the management of population health in response to the Zika and Flint Water crises. A multipronged, mixed-methods approach was used to identify essential education needs and required core competencies. Data were synthesized from discussion with key informants, review of relevant documents, and surveys of schools of nursing, public health, and medicine. The ADDIE model was used to integrate results into the development of the online learning tool kits using the ThingLink software program. An innovative online educational program to prepare healthcare providers to rapidly identify, mitigate, and manage the impact of the Zika and Flint Water crises upon pregnant women and children was implemented by the Society for the Advancement of Disaster Nursing. Innovative online learning tool kits can advance healthcare provider readiness by increasing knowledge and understanding of key components of specific public health emergencies.

Objective: The purpose of this study was to assess, through participant self-assessment, the effectiveness of a rapid response team curriculum based on the World Health Organization (WHO) Ebola Virus Disease Consolidated Preparedness Checklist, Revision 1., Methods: A pre-and-post survey for the purpose of process improvement assessment involving 44 individuals was conducted in Angola. The survey was conducted before and after a 6-day training workshop held in Luanda, Angola, in December 2017. A paired t-test was used to identify any significant change on six 7-point Likert scale questions with α &lt;.05 (95% CI)., Results: Two of the 6 questions, "I feel confident the team can effectively work together to accomplish its assigned goals and objectives during a suspected contagious hemorrhagic fever disease outbreak" and "I understand basic pandemic response concepts" changed significantly from the presurvey to the postsurvey. The 4 remaining questions had near statistical significant change or an upward trend., Conclusion: This Angolan rapid response team training curriculum based on WHO guidelines, After Action Reports, and internationally accepted standard operating procedures provides the nation of Angola with the confidence to rapidly respond at the national level to a highly infectious contagion in the region. (Disaster Med Public Health Preparedness. 2019;13:577-581).

ABSTRACTIntroductionHome health agencies have been tasked to improve their patients' disaster preparedness. Few studies have evaluated the robustness of tools to support preparedness in home health. Through evaluation of the Home-Based Primary Care (HBPC) Patient Assessment Tool, we conducted a survey to identify strengths and challenges in supporting the preparedness of patients served by home health programs such as the Veterans Health Administration's HBPC program. METHODS: Practitioners from 10 HBPC programs fielded the Patient Assessment Tool with all patients during a 3-week period. Logistic regression and bivariate analyses were used to identify patient characteristics associated with the delivery of preparedness education. RESULTS: A total of 754 Patient Assessment Tools were returned. The educational item most likely to be covered was how to activate 911 services (87%). The item least likely to be discussed was information on emergency shelter registration and emergency specialty transportation (44%). When compared to the low risk group, HBPC patients in the high/medium risk group were more likely to receive preparedness education materials for 6 of the 9 educational preparedness items (P values less than 0.05).DiscussionPractitioners are relaying preparedness education to their most vulnerable patients, suggesting that home health agencies can provide disaster preparedness in the home. Nonetheless, there is room for improvement. (Disaster Med Public Health Preparedness. 2019;13:547-554).

Background: Chiyoda City in Tokyo plays a central role in Japanese politics and the economy, with a daytime population of 820,000 and a nighttime population of 50,000. Consequently, companies are required to take measures to ensure the safety of evacuees and employees and to have a minimum knowledge of health care. These requirements necessitate an examination of the contents of intervention and support from the perspective of nursing, as a form of disaster preparedness cooperation among industry, government, and local communities., Objectives: This study aimed to clarify the actual conditions of disaster preparedness and challenges regarding disaster countermeasures faced by companies in Chiyoda City and to examine the types of support required for facilitating disaster preparedness from the perspective of nursing., Methods: Data were collected through semi-structured face-to-face interviews with the six persons in charge of disaster management at companies in Chiyoda City. Qualitative descriptive analysis was used for clarifying the companies' actual disaster preparedness practices and challenges., Results: The participants acknowledged that specific disaster preparedness efforts at each company were carried out based on past experience with accidents and disasters and that their interests and efforts were promoted by associated organizations and not by the company itself. There was a difference in the level of awareness between participants and other employees, which placed a burden on the participants. In addition, numerous problems existed regarding regional cooperation., Conclusions: The results suggest that nurses could play a vital role in education regarding disaster preparedness and in improving awareness of care strategies for disaster victims. This study also indicated the importance of providing psychological support to persons in charge of disaster countermeasures, of confirming the safety of employees' families, and cooperating with regional organizations.

Vulnerability to natural disasters is increasing globally 1-3 . In parallel, the responsibility for natural hazard preparedness has shifted to communities and individuals 4 . It is therefore crucial that households increase their preparedness, yet adoption of household preparedness measures continues to be low, even in high-risk regions 5-8 . In addition, few hazard-preparedness interventions have been evaluated longitudinally using observational measures. Therefore, we conducted a controlled intervention with a 12-month follow-up on adults in communities in the United States and Turkey that focused on improving household earthquake and fire preparedness. We show that this Fix-it intervention, involving evidence-based, face-to-face workshops, increased multihazard preparedness in both cultures longitudinally. Compared to baseline, the primary outcome-overall preparedness-increased significantly in the intervention groups, with more improvement in earthquake preparedness in the Turkish participants and more improvements in fire preparedness in the US participants. High baseline outcome expectancy and home ownership predicted overall preparedness change in both intervention groups longitudinally, implying that a sense of agency influences preparedness. An unintended consequence of observation is that it may increase preparedness, as even the control groups changed their behaviour. Therefore, observation of home preparatory behaviours by an external source may be a way to extend multihazard preparedness across a population.

Purpose: To describe Faculty of Pharmacy experience in the development of an elective course of pharmacist's roles in disaster management for third-year pharmacy students and to evaluate the effectiveness of this innovative teaching module in students' knowledge and their perception of the introduction of this specific course into their curriculum., Methods: An expert team of physicians, surgeons and pharmacists of the Service de Santé des Armées, pharmacists teaching at the Faculty and pharmacists of Bataillon des Marins Pompiers de Marseille defined the program of a 30-hour module in disaster response in line with previously published recommendations, literature analysis and international guidelines on disaster response training. Students' knowledge of key competencies was assessed after each teaching session through a multiple-choice questionnaire. Assessment of self-perceived students' knowledge, teaching quality and students' degree of satisfaction was carried out using a volunteer survey just after the last teaching, the November 15th., Results: The creation of the final curriculum resulted in a course of 6 modules. Concerning the students' knowledge of key competencies, a mean score of 19/25 for the multiple-choice questionnaire was obtained. 98.3% of students reported that this teaching allowed them to improve their knowledge in the field of pharmacist's roles in disaster management. 79.3% of them will recommend this optional course., Conclusion: This teaching represents a potential to increase the number of pharmacists prepared to respond to disasters. It also expands students' understanding of pharmacist's roles and stimulates their interest in emergency preparedness. Further formation, including emergency simulation in mass triage will be conducted next year.

Purpose: Many nurses are trained inadequately in emergency preparedness (EP), preventing them from effectively executing response roles during disasters, such as chemical, biological, radiological, nuclear, and explosive (CBRNE) events. Nurses also indicate lacking confidence in their abilities to perform EP activities. The purpose of this article is to describe the phased development of, and delivery strategies for, a CBRNE curriculum to enhance EP among nursing professionals. The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and the National Center for Disaster Preparedness at Columbia University's Earth Institute led the initiative., Methods: Curriculum development included four phases. In Phases I and II, nursing staff at 20 participating NYC hospitals conducted 7,177 surveys and participated in 20 focus groups to identify training gaps in EP. In Phase III, investigators developed and later refined the CBRNE curriculum based on gaps identified. In Phase IV, 22 nurse educators (representing 7 of the original 20 participating hospitals) completed train-the-trainer sessions. Of these nurse educators, three were evaluated on their ability to train other nurses using the curriculum, which investigators finalized., Findings: The CBRNE curriculum included six modules, a just-in-time training, and an online annual refresher course that addressed EP gaps identified in surveys and focus groups. Among the 11 nurses who were trained by three nurse educators during a pilot training, participant knowledge of CBRNE events and response roles increased from an average of 54% (range 45%-75%) on the pre-test to 89% (range 80%-90%) on the posttest., Conclusions: By participating in nursing CBRNE training, nurses increased their knowledge of and preparedness to respond to disasters. The train-the-trainer curriculum is easily adaptable to meet the needs of other healthcare settings., Clinical Relevance: The CBRNE curriculum can be used to train nurses to better prepare for and more effectively respond to disasters., (Published 2018. This article is a U.S. Government work and is in the public domain in the USA.)

Objective: A common method of disaster training is needed to improve disaster nursing education and facilitate better communication among interprofessional disaster responders. To inform the development of disaster nursing curricula, a novel disaster nursing education method consistent with Homeland Security Exercise and Evaluation Program (HSEEP) and the International Council of Nurses (ICN) framework was developed to improve disaster nursing competencies in a baccalaureate nursing program., Methods: In total, 89 undergraduate nursing students participated. Perceived disaster nursing knowledge, confidence, and training/response were assessed with 14 items before and after the education., Results: Exploratory factor analysis showed 3 factors, knowledge, confidence, and training/response, explained 71% of variation in items. Nursing students showed large improvements in perceived disaster nursing knowledge (t=11.95, P&lt;0.001, Cohen's d=1.76), moderate increases in perceived confidence (t=4.54, P&lt;0.001, d=0.67), and no change in disaster training and response (t=0.94, P=0.351, d=0.13)., Conclusions: Results show preliminary evidence supporting the effectiveness of disaster nursing education informed by HSEEP. This training has the potential to fill current practice gaps in disaster nursing knowledge and build confidence to use those skills in practice. (Disaster Med Public Health Preparedness. 2018;12:703-710).

Objective: To examine the impact of a simulation training in raising a group of young students' personal and situational awareness in disasters and emergencies., Methods: In total, 25 young students participated in two simulation scenarios representing two actual events, fire, and shooting, using a combination of two validated simulation training (Emergency Management and Preparedness Training for Youth [EMPTY]). The changes in their knowledge and awareness were evaluated by using questionnaires and the whole simulation was evaluated by three independent observers and a reference group., Results: New concepts of emergency management, for example, evacuation, and barricading, could be trained in a safe environment. There was a significant increase in students' personal and situational awareness and their active engagement in the management of emergencies., Conclusion: EMPTY could raise the youth basic knowledge and ability to understand the concept of preparedness by being mentally prepared, available for collaboration, gaining a higher confidence, understanding the physical and psychological consequences of a major incident and the importance of their own safety. (Disaster Med Public Health Preparedness. 2018;12:685-688).

Objective: The US Veterans Health Administration's Disaster Emergency Medical Personnel System (DEMPS) is a team of employee disaster response volunteers who provide clinical and non-clinical staffing assistance when local systems are overwhelmed. This study evaluated attitudes and recommendations of the DEMPS program to understand the impact of multi-modal training on volunteer perceptions., Methods: DEMPS volunteers completed an electronic survey in 2012 (n=2120). Three training modes were evaluated: online, field exercise, and face-to-face. Measures included: "Training Satisfaction," "Attitudes about Training," "Continued Engagement in DEMPS." Data were analyzed using χ2 and logistic regression. Open-ended questions were evaluated in a manner consistent with grounded theory methodology., Results: Most respondents participated in DEMPS training (80%). Volunteers with multi-modal training who completed all 3 modes (14%) were significantly more likely to have positive attitudes about training, plan to continue as volunteers, and would recommend DEMPS to others (P-value&lt;0.001). Some respondents requested additional interactive activities and suggested increased availability of training may improve volunteer engagement., Conclusions: A blended learning environment using multi-modal training methods, could enhance satisfaction and attitudes and possibly encourage continued engagement in DEMPS or similar programs. DEMPS training program modifications in 2015 expanded this blended learning approach through new interactive online learning opportunities. (Disaster Med Public Health Preparedness. 2018;12:744-751).

Objectives: To assess the knowledge, practices, and attitudes regarding disaster and emergency preparedness among Emergency Department (ED) staff. Methods: This cross-sectional study was conducted at Tertiary health care hospital in central Riyadh, Kingdom of Saudi Arabia. A self-administered survey was utilized to collect data from ED physicians and nurses. The questionnaire was divided into 5 sections viz; demographics, knowledge about disaster management and preparedness, attitudes about disaster planning, current role and practices, and familiarity towards emergency. Results: A 189 participants have completed the questionnaire. Two-third of the participants were below 30 years, and more than 85% were female. One hundred and eleven (58.7%) had a clinical experience of more than 5 years, while 78 (41.3%) participants had more than 3 years of clinical service at the Tertiary care hospital in Riyadh, Kingdom of Saudi Arabia. Correct responses of knowledge towards disaster and emergency preparedness score was 6.2±2.5. Participants with more than 5-years of experience had a statistically significant (p=0.009) knowledge scale score for disaster and emergency preparedness. Overall, 186 (98.4%) patients believed that training is necessary for all healthcare workers. Approximately 153 (81%) participants reported the conduct of disaster drill at their hospital. The mean score (Mean±SD) for the overall familiarity of the study participants with emergency preparedness information questionnaire (EPIQ) scale was 3.2±1.3. Conclusion: The level of knowledge was satisfactory among healthcare providers with neutral level of attitude, practice, and familiarity regarding disaster preparedness. Follow-up research is necessary for maximizing ED preparedness.

Despite high awareness of the need, opportunities for nurses to gain disaster experience or training are limited. In Korea, most disaster training is done in an undergraduate curriculum where there is very limited practice, and the educational topics are mostly focused on the field aspect of disaster events. The purpose of this study was to determine the need for such training for hospital nurses and to determine appropriate and relevant components of the training contents. A qualitative survey approach using the modified Delphi method was used to collect and analyze the data. The surveys were conducted in 3 rounds. After the results were analyzed from the third-round survey, the authors finalized the contents for a training program to prepare nurses for their roles during disasters. Through a structured needs analysis using a modified Delphi survey, the framework for the content development of disaster training curriculum for hospital nurses was developed.

Background: Operating theatre services can be heavily relied upon during mass casualty disaster events, which require nurses to have adequate training and education of hospital disaster management plans to respond appropriately. The evidence-base of disaster preparedness in the acute setting is limited, particularly with regard to operating theatre nurses., Objectives: Explore operating theatre nurse's disaster knowledge of their role in a mass casualty event, and identify the preferred mode of disaster education and training to improve disaster preparedness., Design: A cross-sectional research design was employed with data collected using a survey tool., Settings: The research was undertaken on operating theatre nurses in a tertiary hospital in Victoria, Australia., Participants: The participants in this research included 53 operating theatre nurses, 51 Registered Nurses and 2 Enrolled Nurses., Methods: The survey was based on a disaster questionnaire for emergency department nurses from South Australia, exploring knowledge and preparedness for disaster response in the acute setting, and altered to be specific and relevant to the operating theatre environment and broadened to focus on the training needs of perioperative nurses., Results: The survey of 53 operating theatre nurses identified that few had previous disaster experience (19.9%). The majority of respondents were aware of their disaster management policy (Code Brown policy) (94.1%), of reporting lines, and appropriate triage (80.4%). However, a significant number of nurses (50.9%) stated that in the event of a disaster they would "call work to see if [they needed] additional assistance" compared with 43.4% of respondents "wait to be contacted by a manager/floor coordinator" as was policy. Finally, disaster nursing general knowledge amongst staff was poor; a mean of 1.79 (SD = 1.20) correct answers out of a possible 7., Conclusions: This study highlights that disaster education and training methods for disasters be specific to the role required by nurses and all staff during a disaster activation; training drills are preferred although face-to-face education is practical., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: The number of natural disasters occurring worldwide has increased, including Indonesia, a country that continues to experience natural disasters of varying level of severity. Despite this evidence, limited information is available about nurses' disaster preparedness in Indonesia particularly in community settings. This study aims to identify the current level of disaster preparedness and learning needs for managing natural disasters as perceived by community health nurse (CHN) coordinators who are working in community health settings in South Sulawesi, Indonesia., Methods: This study used a descriptive study design. A self-administered survey, the Disaster Preparedness Evaluation Tools (DPET ® ) was utilized to determine the current levels of disaster preparedness and management of the CHN coordinators. In addition, structured questions were used to identify learning needs. It was distributed to 254 CHN coordinators working in community health settings in South Sulawesi Province, Indonesia., Results: In total 214 CHN coordinators completed the survey. There were around 6.5% respondents perceived their current disaster preparedness as weak; 84.6% moderate; and 8.9% rated their preparedness as strong. Around one-third of the participants considered frequent disaster drills as the best learning method to achieve effective disaster preparedness., Conclusion: Although overall disaster preparedness levels of the CHN coordinators in South Sulawesi province Indonesia were moderate, continuing disaster training that integrates CHN coordinators specific learning needs is still required to achieve effective disaster preparedness and management in community levels., (Copyright © 2017. Published by Elsevier Ltd.)