Disaster Medicine and Public Health Preparedness最新文献

One of the most relevant types of human-made disasters, due to its intense and long-lasting effects on health, is the so-called Complex Emergency (CE) or Complex Humanitarian Emergency, defined since the early 1990s as "a relatively acute situation affecting a large civilian population, usually involving a combination of a situation of war or massive civil disturbance, food insecurity or shortage, and population displacement, resulting in a significant increase in mortality."

The RNCP/NIAID recommends the creation of a North American Biodosimetry Assessment Networking Group (BANG) by developing a blueprint for integrating the relevant national capabilities to provide emergency biodosimetry assistance in civilian populations following a radiological or nuclear incident. The goals of BANG are to: 1) establish a collaborative network (public/private partnership) and engage its membership to address emergency preparedness, response, and recovery, 2) promote strategic relationships between network members to encourage resource sharing, 3) engage with stakeholders to utilize recommended tools and support training exercises, and 4) advance bioinformatics and machine learning approaches to integrate and utilize the network data for managing emergency situations.To be adequately prepared for large-scale radiological or nuclear incidents, a coordinated network among well-trained, commercial, hospital, and/or academic laboratories is a critical factor for providing rapid exposure assessments. Interactive and productive collaborations between North American laboratories will improve the capabilities of the network by offering a wider range of complementary biological and physical techniques. BANG would connect community service providers with various biodosimetry capabilities, and enable members to discuss best practices, common goals, emergency planning/ training, and sharing of resources, to increase the nation's resiliency before, during, and after a radiological public health emergency.

Objective: The study objective was to compile and rate expert-informed recommendations to enhance US Military Health System (MHS) pandemic preparedness, with implications for large civilian health systems and national preparedness.

Methods: A Modified Delphi process was used to assess the importance and feasibility of pandemic preparedness recommendations from Department of Defense (DoD) after-action reports and inspector general reviews. The process consisted of a pre-work phase and 4 rounds of panelist engagement. Panelists rated each recommendation on both importance and feasibility using a Likert scale.

Results: Thirty panelists participated in the interview round, 21 completed the first round of asynchronous rating, 15 participated in the second round of consensus rating, and 14 attended the final consensus conference. The Delphi process began with 102 recommendations; at completion, 25 recommendations were rated high importance and high feasibility. Recommendations addressed key domains including support to civil authorities, public health emergency management, personnel, and policy.

Conclusions: The 25 highest-rated recommendations highlight key areas for enhancing MHS planning for future pandemic preparedness, such as civilian-military coordination, telehealth expansion, and supply chain resilience. While tailored to the MHS, the findings highlight critical areas relevant to civilian health systems and national preparedness, including public health measures, interagency coordination, and resource management.

Objectives: A nuclear detonation resulting in radiation exposure to a large population can cause acute radiation syndrome (ARS). Bone marrow colony stimulating factors (CSF), also known as cytokines, are FDA approved to treat hematopoietic-acute radiation syndrome (H-ARS). This review characterizes the use of CSFs (filgrastim, pegfilgrastim, romiplostim, and sargramostim) and stem cell therapies for H-ARS.

Methods: Using identified keywords, the literature search was conducted on biomedical databases from January 1996-July 2022 and returned 7452 articles. However, after review based on PICO and exclusion criteria, a total of 39 animal studies were included in this systematic review.

Results: Data synthesis using vote counting demonstrated that 34 of 39 studies reported benefit with CSFs or stem cell therapies based on an increase in percent survival or physiological improvement in the experimental group when compared to the control (87% [95% CI 71.77%-95.18%], P = <0.001).

Conclusions: While studies looking at efficacy of CSFs given after 24 hours were limited, 2 studies included in this review showed that delayed administration of CSFs up to 120 hours may be beneficial compared to no treatment. Lack of standardization in experimental study design (e.g. radiation doses, animal species, interventions) between studies prevented direct comparisons using meta-analytic statistical approach.

The convergence of nuclear and radiological preparedness with epidemic and pandemic response, reveals valuable opportunities for cross-disciplinary learning and capability development. Insights from the extensive career of Dr. C. Norman Coleman illustrate how methodologies from radiation medical countermeasures can inform strategies for managing emerging infectious diseases. While nuclear incidents are infrequent, infectious disease outbreaks occur regularly, underscoring the need for sustained, adaptable capabilities to detect and respond to such threats. To draw on some examples, case studies on the development and deployment of vaccines against filoviruses highlight measurable advances in response speed and efficacy, while persistent challenges related to equitable access to medical countermeasures during public health emergencies can be addressed drawing lessons from the COVID-19 pandemic. Iterative improvement, strategic planning and performance optimization is very important, as is, the value of understanding the structure of a problem to find its solution.

This 2025 supplemental issue of Disaster Medicine and Public Health Preparedness (DMPHP) honors Dr. C. Norman (Norm) Coleman who dedicated his life to applying his expert knowledge of radiation to develop elegant, science-based solutions to incredibly complex problems such as the public health and medical response to radiological disasters and creating a corps of experts to provide quality cancer care for people in developing countries.

This paper addresses the challenges and preparedness strategies for health care systems in responding to nuclear and radiological emergencies. It emphasizes the critical role of medical centers in pre-incident preparedness, immediate response, and long-term care, focusing on the need for coordinated efforts between local, state, and federal agencies. Key components include specialized training, resource allocation, triage protocols, and the integration of networks like the Radiation Injury Treatment Network and the American Burn Association. This paper highlights the importance of resilience through collaboration, infrastructure planning, and community support to manage mass casualties and mitigate long-term health consequences. It underscores the lessons learned from historical responses and contemporary challenges, advocating for a proactive approach to enhance health care system readiness in the face of catastrophic events.

Objective: Health systems have finite capacity. During crises, policymakers may explicitly reallocate health system resources, or capacity limitations may necessitate implicit resource reallocation. This study modelled timing and intensity of pre-vaccination health system resource reallocation policies to predict excess mortality during the COVID-19 pandemic.

Methods: This longitudinal panel analysis included 85 countries (752 country-months, January 2020-January 2021). The predictor was resource reallocation scope, scale (summarized as intensity, 0-100), and timing. The outcome was all-cause excess mortality (percentage deaths greater than historical average/month). Covariates included COVID-19 incidence and health system parameters.

Results: Simultaneous health system resource reallocation was associated with increased mortality in multivariate models (b = 0.80, 95%CI 0.42-1.18). However, preemptive (previous month's) resource reallocation was protective against excess mortality (b = -0.58, 95%CI -0.93-0.23: e.g., 42,010 fewer deaths per unit increased resource reallocation, March 2020, all study countries). Effects were magnified in older populations. Health system capacity and preparedness were associated with lower mortality.

Conclusions: In the pre-vaccination COVID-19 pandemic, preemptive health system resource reallocation was associated with lower mortality, whereas simultaneous resource reallocation was associated with greater mortality. This longitudinal multinational study indicates that readiness, capacity building, and proactive resource reallocation improve crisis response.

Aim: This study analyzes the scientific literature on disaster medicine and medical rescue between 1992 and 2024 using bibliometric methods, focusing on productivity, collaboration networks, and thematic trends.

Method: Original articles were retrieved from the Web of Science Core Collection using the TS field with the terms: ("disaster medicine") AND ("emergency medical services" OR "public health") for disaster medicine, and ("disaster medicine") AND ("emergency medical services" OR "public health") AND ("medical rescue" OR "medical triage" OR "medical transport") for medical rescue. A total of 727 articles were analyzed (654 disaster medicine, 73 medical rescue). Bibliometric analyses were performed with RStudio 4.4.2, applying Bradford's and Lotka's laws.

Results: Disaster medicine publications received an average of 12.9 citations and emergency medical rescue publications 11.6 citations per year. The international co-authorship rate was 25.1% in disaster medicine and 30.1% in emergency medical rescue. The core journals are Disaster Medicine and Public Health Preparedness and Prehospital and Disaster Medicine in disaster medicine, and Prehospital and Disaster Medicine in emergency medical rescue on both measures. In the last decade, the themes of "preparedness resilience-public health" in disaster medicine and "management-simulation-triage" in emergency medical rescue have increased.

Conclusion: Disaster medicine publications have increased steadily, particularly in themes such as preparedness, resilience, and public health. In contrast, medical rescue research remains smaller in volume and focuses more on operational themes such as management, simulation, and triage.