Health Security最新文献

Labor actions by healthcare workers are increasing in frequency and quantity, particularly throughout the United States. Regardless of their cause and size, these strikes could disrupt normal hospital operations and impact patient access to care, quality of care, and costs. Strikes resemble other large-scale incidents like natural disasters, pandemics, or terrorist attacks by shrinking a hospital's capacity to care for patients, forcing hospitals to pursue logistically complicated actions such as finding replacement providers, and impacting nearby facilities due to patient offloading. In contrast to these incidents, however, strikes are unique because they come with advance notice, reduce capacity by precise amounts with predictable provider losses, occur during defined periods, and do not necessarily increase demand for patient care. To maximize efficiency and minimize disruption in response to strikes, hospitals must properly plan ahead and successfully execute their plans. In this article, we recount the experience of a 2023 resident strike at NYC Health + Hospitals/Elmhurst in New York City and describe 6 core strategies that the facility implemented to maintain quality care: strike aversion and planning, increasing coverage, decreasing demand, internal and external messaging, external partnerships, and demobilization. We also provide a planning template that other hospitals can use to prepare for and respond to healthcare provider strikes. The information in this article was first presented as a poster, "Healthcare Labor Action Preparedness and Response" at the Preparedness Summit, March 25-28, 2024, in Cleveland, Ohio.

Student interview teams provided essential surge capacity for the conduct of routine enteric disease surveillance and outbreak activities during the COVID-19 pandemic response, for states with that resource available. This case study describes how student interview teams based in Colorado and Washington supported enteric disease interviewing for public health agencies in Nebraska, Wyoming, Kansas, and California, and demonstrates the feasibility and value of interstate student interview team work to provide enteric and other communicable disease surge capacity. In collaboration with their respective state health agencies, the Colorado School of Public Health Enteric Disease Interview Team (EDIT) and the University of Washington Student Epidemic Action Leaders (SEAL) team amended scopes of work and procedures for hiring and onboarding, training, work management and engagement, communication, and evaluation to offer enteric disease interviewing support to the Nebraska Department of Health and Human Services, the Wyoming Department of Health, the Kansas Department of Health and Environment, and the California Department of Public Health. EDIT was assigned 467 enteric interviews in Nebraska, 193 in Wyoming, and 33 in Kansas; and the SEAL team was assigned 133 interviews from 26 clusters in California, with response rates of 68%, 79%, 58%, and 53%, respectively. The median time from case assignment to first interview for EDIT interviews was less than or equal to 1 day. The completeness of all interviews was satisfactory. Enteric disease epidemiologists from host state health departments and students reported valuing the interstate work. Establishing interstate student interview team support requires coordination but is possible and can be effective in providing essential surge capacity for states without a student interview team. It also provides intangible benefits such as strengthening relationships between states and affiliated university programs and providing professional experiences and networking opportunities for students.

From influenza to COVID-19, emerging infectious diseases have taken a heavy toll on lives and resources. Emerging infectious diseases represent one of the largest threats to national security. The primary mission of the Center for Biomedical Advanced Research and Development Authority (BARDA), within the US Administration for Strategic Preparedness and Response, is to support the advanced development of medical countermeasures (MCMs) for public health security threats, including select infectious diseases. Given the number of potential emerging infectious diseases, it is not feasible to develop a suite of MCMs necessary for a full response, including vaccines, therapeutics, and diagnostics. In this article, the authors describe BARDA's 3-step strategy to address emerging infectious diseases: (1) prioritize the development of MCMs for BARDA's priority pathogens with an increased focus on "platform technologies" with rapid development capabilities; (2) develop response capabilities including specific licensed medical countermeasures and flexible, rapid MCM development infrastructure; and (3) improve those response capabilities, so they are finely tuned and ready when needed.

The Joint External Evaluation tool is a World Health Organization-recommended method for evaluating countries' capacities under the International Health Regulations (2005) (IHR). It encompasses a national preparedness assessment process for public health threats and offers a structured framework for planning and implementing effective response measures. A tailored approach is necessary for Nigeria's federated system of government, in which most constitutional requirements for public health and associated issues are decentralized to the state level. The Nigeria Centre for Disease Control and Prevention (NCDC) developed an assessment tool to identify state-level health security gaps and support the development of improvement plans. With input from state and national public health leaders and legal experts, a legislative evaluation was conducted to determine specific IHR activities that could be implemented within the state's legal framework to accelerate the implementation of the Integrated Disease Surveillance and Response strategy and IHR. The resulting assessment instrument was piloted in Kano, Enugu, and Kebbi states, followed by a consensus meeting to identify additional areas for improvement. The revised tool contains 14 technical areas and 35 indicators tailored to implementing improvement plans. By recognizing the unique characteristics of subnational entities and their implications for pandemic preparedness, the tool provides an innovative approach to health security for countries with multilayered governance structures or geographic diversity. Conducting a subnational health security assessment is a crucial step in ensuring preparedness for public health threats and enhancing health security in Nigeria's federated system of government.

The United States takes a federalist approach to pandemic responses while the bulk of pandemic powers sits at the state level. Thus, comprehensive accounts of how state health officials managed the crisis and how the federal government affected those efforts are needed to better understand the governmental response to the COVID-19 pandemic. This article reports the results of semistructured interviews with 29 state-level policy actors from 16 US states. Interviewees discussed multiple aspects of the US federal COVID-19 response that affected the response in their states, including communications with the public, intergovernmental communications, and federal actions regarding various aspects of health service preparedness including emergency funding, procurement, testing capacity, vaccine development and distribution, and data systems. This research enriches the discussion about US pandemic preparedness and response, and indicates that alignment of public communications across government levels, enhanced intergovernmental communication, inclusion of rural perspectives, and federal investment in and sustainment of health service preparedness are key factors that can improve future US pandemic responses.

We led the last large-scale exercise conducted by the Johns Hopkins Center for Health Security before the COVID-19 pandemic. Despite COVID-19, pandemic exercises are more necessary than ever to prevent the loss of hard-fought gains achieved during COVID-19, keep policymakers from assuming all pandemics will be like COVID-19, and encourage continued engagement from policymakers in strengthening health resilience rather than returning to a cycle of panic and neglect. Pandemic exercises can also advance new solutions necessary to effectively meet the challenge of a future pandemic. Over 2 decades, the Johns Hopkins Center for Health Security has developed and conducted 6 large-scale, high-level tabletop pandemic exercises. These exercises and others were designed to increase policy focus on the most critical needs in pandemic preparedness and heighten the urgency for making these changes in the near future. Pandemic experts and policymakers alike have highlighted the importance of exercises to ensure that all key actors involved in pandemic response-including the government, healthcare, public health, emergency response, and private business and industry sectors-understand both the best practices and policies to pursue before a pandemic and what to do once a pandemic occurs. These advance efforts can enhance planning, resource allocation, and coordination ahead of time and identify unique gaps and barriers. This commentary describes the approach we have developed to create and conduct such exercises and highlights key considerations that were important to successful outcomes.

Emergency department (ED) visit volumes have increased since 2007, with crowding in the United States reaching its highest levels in 2022. During this same period, mass casualty incidents (MCIs) have increased dramatically, both in frequency and severity, across the United States. Resuscitation of trauma patients is a time-sensitive process that requires immediate patient assessment by coordinated clinical teams in order to successfully diagnose and manage life-threatening injuries. To make resuscitation spaces immediately available for incoming patients, typical MCI plans call for rapidly relocating ED patients from their rooms into hallways or transferring them to open inpatient areas. With current levels of crowding, however, such alternate care spaces are often already in use and traditional MCI plans are increasingly unrealistic. With ED crowding worsening and the frequency of MCIs rising, there is a worrisome risk that EDs could fail in their efforts to save patients due to insufficient resources and spaces to meet the demands of critically injured patients. Hospitals must use innovative, novel response strategies to ensure sufficient patient care spaces in a short timeframe to save the most lives possible. In this commentary, we describe the use of buffer zones to help EDs mobilize an effective response to MCIs in the current context of severe hospital crowding.

The National Disaster Medical System (NDMS) is a US federally coordinated healthcare system that aims to strengthen its capacity for surge management. We conducted a literature review to aid in the development of a research landscape analysis and strategy for the ongoing NDMS Pilot Program. The review was performed to identify surge management literature published from 2001 to spring 2023. Articles were screened using eligibility criteria and selected for analysis based on a consensus process. The search yielded 504 unique articles after deduplications. After abstract screening, 100 articles were screened for relevance. The final sample included 28 articles that were analyzed using themes relevant to the NDMS Pilot Program. This article discusses lessons learned and recommendations for program leadership to optimize outcomes during a surge event. NDMS should consider methods for improving situational awareness during surge events and should include stakeholders in planning and evaluation of the NDMS Pilot Program. Priority recommendations include strengthening operational coordination and leadership, enhancing information-sharing capabilities, and addressing funding and resource allocation. Findings from this review highlight current practices in surge management as well as gaps in current operational research areas. Addressing these gaps has the potential to strengthen the capacity of the NDMS Pilot Program and health system disaster preparedness more broadly across the United States.