American journal of disaster medicine最新文献

Context: The prevalence of both heart failure and vitamin D deficiency increases with age and is associated with poor outcome in the elderly.

Objectives: We aimed to investigate the relationship between all-cause mortality and vitamin D deficiency in elderly patients with chronic heart failure.

Design: It is a retrospective, observational cross-sectional study. Median follow-up time was 497 days.

Subjects and methods: 302 patients aged ≥65 years heart failure patients was categorized into tertiles based on the 25-hydroxy-vitamin D levels. Clinical and laboratory parameters were evaluated according to tertiles. Hospitalization rates and overall survival were compared between tertiles. Independent predictors of all cause mortality were defined.

Results: Patients with low vitamin D tertile were mostly women (p=0.001), and had a worse NYHA functional class (p=0.005). During follow-up, deaths were more frequent in the first tertile (p = 0.001). All-cause mortality increased significantly with decreasing vitamin D tertiles (from third tertile 7.9%, to 11.9%, to 26%; log rank test p=0.003). No significant difference was observed at the composite endpoint of mortality or HF hospitalizations (P=0.451). Multivariate analysis supported that low vitamin D concentration was an independent predictor of all causes of mortality (HR 0.93; 95% CI 0.89-0.97; p=0.004).

Conclusions: Low vitamin D levels were independent predictors of all-cause mortality in the elderly population with chronic heart failure.

Connecticut was impacted severely and early on by the COVID-19 pandemic due to the state's proximity to New York City. Hartford Healthcare (HHC), one of the largest healthcare systems in New England, became integral in the state's response with a robust emergency management system already in place. In this manuscript, we review HHC's prepandemic emergency operations as well as the response of the system-wide Office of Emergency Management to the initial news of the virus and throughout the evolving pandemic. Additionally, we discuss the unique acquisition of vital critical care resources and personal protective equipment, as well as the hospital personnel distribution in response to the shifting demands of the virus. The public testing and vaccination efforts, with early consideration for at risk populations, are described as well as ethical considerations of scarce resources. To date, the vaccination effort resulted in over 70 percent of the adult population being vaccinated and with 10 percent of the population having been infected, herd immunity is eminent. Finally, the preparation for reestablishing elective procedures while experiencing a second wave of the pandemic is discussed. These descriptions may be useful for other healthcare systems in both preparation and response for future catastrophic emergencies of all types.

Objective: Many hospitals were unprepared for the surge of patients associated with the spread of coronavirus disease 2019 (COVID-19) pandemic. We describe the processes to develop and implement a surge plan framework for resource allocation, staffing, and standardized management in response to the COVID-19 pandemic across a large integrated regional healthcare system.

Setting: A large academic medical center in the Cleveland metropolitan area, with a network of 10 regional hospitals throughout Northeastern Ohio with a daily capacity of more than 500 intensive care unit (ICU) beds.

Results: At the beginning of the pandemic, an equitable delivery of healthcare services across the healthcare system was developed. This distribution of resources was implemented with the potential needs and resources of the individual ICUs in mind, and epidemiologic predictions of virus transmissibility. We describe the processes to develop and implement a surge plan framework for resource allocation, staffing, and standardized management in response to the COVID-19 pandemic across a large integrated regional healthcare system. We also describe an additional level of surge capacity, which is available to well-integrated institutions called "extension of capacity." This refers to the ability to immediately have access to the beds and resources within a hospital system with minimal administrative burden.

Conclusions: Large integrated hospital systems may have an advantage over individual hospitals because they can shift supplies among regional partners, which may lead to faster mobilization of resources, rather than depending on local and national governments. The pandemic response of our healthcare system highlights these benefits.

Background: Many hospital units, including obstetric (OB) units, were unprepared when the novel coronavirus began sweeping through communities. National and international bodies, including the World Health Organization, Centers for Disease Control Prevention, and the American College of Obstetricians and Gynecologists, directed enormous efforts to present the latest evidence-based practices to healthcare institutions and communities. The first hospitals that were affected in China and the United States (US) did heroic work in assisting their colleagues with best practices they had acquired. Despite these resources, many US hospitals struggled with how to best incorporate and implement this new information into disaster plans, and many protocol changes had to be established de novo. In general, disaster planning for OB units lagged behind other disaster planning performed by specialties such as emergency medicine, trauma, and pediatrics.

Participants: Fortunately, two pre-existing collaborative disaster groups, the OB Disaster Planning Workgroup and the Western Regional Alliance for Pediatric Emergency Management, were able to rapidly deploy during the pandemic due to their pre-established networks and shared goals.

Main outcome: These groups were able to share best practices, identify and address knowledge gaps, and disseminate information on a broad scale. The case will be made that the OB community needs to establish more such regional and national disaster committees that meet year-round. This will ensure that in times of urgency, these groups can increase the cadence of their meetings, and thus rapidly disperse time-sensitive policies and procedures for OB units nationwide.

Conclusion: Given the unique patient population, it is imperative that OB units establish regional coalitions to facilitate a coordinated response to local and national disasters.

Background: State Health Departments are at the helm of addressing the myriad needs during the COVID-19 pandemic, including those of vulnerable populations who do not have a place to self-isolate or quarantine to prevent the spread. An estimated 5,000 Arkansas residents face homelessness and are at increased risk of contracting and spreading COVID-19. Additionally, those living in multigenerational families face similar challenges.

Objective: We share our experiences and lessons learned in planning, executing, and maintaining a quarantine and isolation facility for vulnerable population during the COVID-19 pandemic.

Setting and patients: A 29-bed quarantine and isolation facility was instituted and maintained by the Arkansas Department of Health to meet the quarantine and isolation needs of vulnerable populations. Outcomes and conclusions: As the COVID-19 pandemic persists, need for a facility to meet quarantine and isolation requirements of vulnerable population is not just a critical mitigation strategy but is an ethical imperative.

Objective: To capture organizational level information on the current state of public health emergency response leadership training.

Design: A web-based questionnaire.

Participants: This multitiered assessment of health departments included two distinct respondent groups: (1) Public Health Emergency Preparedness (PHEP) Cooperative Agreement recipients (n = 34) and (2) local health departments (LHDs) (n = 169) representative of different agency sizes and populations served.

Results: Overall, PHEP and LHD respondents expressed a clear preference for participatory learning with practical drills/exercises and participatory workshops as the preferred training delivery modes. Compared with technical and role-specific training, leadership training was less available. For both PHEP and LHD respondents, staff availability for training is most notably limited due to lack of time. For PHEP respondents, a common factor limiting agency ability to offer training is lack of mentors/instructors, whereas for LHD respondents, it is limited funding.

Conclusions: Efforts should focus on increasing accessibility and the continued development of rigorous and effective training based on practical experience in all aspects of multitiered public health emergency response leadership.

Beginning in the 1960s as a tool to disaggregate complicated auto injuries, the Haddon matrix has evolved into a modern method of analyzing complex public health challenges. Throughout the United States and internationally, music festivals have become a rapidly growing and increasingly complex area of mass gathering medicine. Given the austere environment and inherent challenges of providing medical care during a music festival, we utilized a modified Haddon matrix. The objective is to assess the relevant human, physical, and sociocultural factors that impact these festivals throughout the pre-event, event, and post-event time periods. This will ensure an all-hazards preparedness approach to the historically high incidence of traumatic injuries and polysubstance abuse, coupled with modern challenges such as infectious diseases and acts of intentional violence.

Introduction: Little is known about prehospital availability and use of medications to treat patients from hazardous materials (hazmat) medical emergencies. The aim of this study was to identify the availability and frequency of use of medications for patients in hazmat incidents by paramedics with advanced training to care for these patients.

Methods: A prospectively validated survey was distributed to United States paramedics with advanced training in the medical management of patients from hazmat incidents who successfully completed a 16-hour Advanced Hazmat Life Support (AHLS) Provider Course from 1999 to 2017. The survey questioned hazmat medication availability, storage, and frequency of use. Hazmat medications were considered to have been used if administered anytime within the past 5 years. For analyses, medications were grouped into those with hazmat indications only and those with multiple indications.

Results: The survey email was opened by 911 course participants and 784 of these completed the survey (86.1 percent). Of these 784 respondents, 279 (35.6 percent) reported carrying dedicated hazmat medication kits, ie, tox-boxes, and 505 (64.4 percent) did not carry tox-boxes. For those medications specifically for hazmat use, hydroxocobalamin was most commonly available, either within or not within a dedicated tox-box. Of the 784 respondents, 313 (39.9 percent) reported carrying hydroxocobalamin and 69 (8.8 percent) reported administering it within the past 5 years. For medications with multiple indications, availability and use varied: for example, of the 784 respondents, albuterol was available to 699 (89.2 percent) and used by 572 (73.0 percent), while calcium gluconate was available to 247 (31.5 percent) and used by 80 (10.2 percent) within the last 5 years.

Conclusion: Paramedics with advanced training in the medical management of patients in hazmat incidents reported limited availability and use of medications to treat patients in hazmat incidents.

Since the events of 9/11, a concerted interagency effort has been undertaken to create comprehensive emergency planning and preparedness strategies for management of a radiological or nuclear event in the US. These planning guides include protective action guidelines, medical countermeasure recommendations, and systems for diagnosing and triaging radiation injury. Yet, key areas such as perception of risk from radiation exposure by first responders have not been addressed. In this article, we identify the need to model and develop new strategies for the medical manage-ment of large-scale population exposures to radiation, examine the phenomena of radiation dread and its role in emergency response, and review recent findings on the willingness to work of first responders and other personnel involved in mass casualty medical management during a radiological or nuclear event.