Disaster medicine and public health preparedness
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Disaster Med Public Health Prep · Dec 2012
User-managed inventory: an approach to forward-deployment of urgently needed medical countermeasures for mass-casualty and terrorism incidents.
The user-managed inventory (UMI) is an emerging idea for enhancing the current distribution and maintenance system for emergency medical countermeasures (MCMs). It increases current capabilities for the dispensing and distribution of MCMs and enhances local/regional preparedness and resilience. In the UMI, critical MCMs, especially those in routine medical use ("dual utility") and those that must be administered soon after an incident before outside supplies can arrive, are stored at multiple medical facilities (including medical supply or distribution networks) across the United States. ⋯ In an emergency, these extra supplies can be used locally to treat casualties, including evacuees from incidents in other localities. This system, which is at the interface of local/regional and federal response, provides response capacity before the arrival of supplies from the Strategic National Stockpile (SNS) and thus enhances the local/regional medical responders' ability to provide life-saving MCMs that otherwise would be delayed. The UMI can be more cost-effective than stockpiling by avoiding costs due to drug expiration, disposal of expired stockpiled supplies, and repurchase for replacement.
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Disaster Med Public Health Prep · Dec 2012
Challenges and strategies for climate change adaptation among Pacific Island nations.
Few regions of the world are at higher risk for environmental disasters than the Pacific Island countries and territories. During 2004 and 2005, the top public health leadership from 19 of 22 Pacific Island countries and territories convened 2 health summits with the goal of developing the world's first comprehensive regional strategy for sustainable disaster risk management as applied to public health emergencies. These summits followed on the objectives of the 1994 Barbados Plan of Action for the Sustainable Development of Small Island Developing States and those of the subsequent Yokohama Strategy and Plan of Action for a Safer World. The outputs of the 2004 and 2005 Pacific Health Summits for Sustainable Disaster Risk Management provide a detailed description of challenges and accomplishments of the Pacific Island health ministries, establish a Pacific plan of action based upon the principles of disaster risk management, and provide a locally derived, evidence-based approach for many climate change adaptation measures related to extreme weather events in the Pacific region. The declaration and outputs from these summits are offered here as a guide for developmental and humanitarian assistance in the region (and for other small-island developing states) and as a means for reducing the risk of adverse health effects resulting from climate change.
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Disaster Med Public Health Prep · Oct 2012
Rural mass casualty preparedness and response: the Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events.
The Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a workshop at the request of the Federal Interagency Committee on Emergency Medical Services (FICEMS) that brought together a range of stakeholders to broadly identify and confront gaps in rural infrastructure that challenge mass casualty incident (MCI) response and potential mechanisms to fill them. This report summarizes the presentations and discussions around 6 major issues specific to rural MCI preparedness and response: (1) improving rural response to MCI through improving daily capacity and capability, (2) leveraging current and emerging technology to overcome infrastructure deficits, (3) sustaining and strengthening relationships, (4) developing and sharing best practices across jurisdictions and sectors, (5) establishing metrics research and development, and (6) fostering the need for federal leadership to expand and integrate EMS into a broader rural response framework.
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Disaster Med Public Health Prep · Jun 2012
Comparative StudyComparison of severity of illness scores to physician clinical judgment for potential use in pediatric critical care triage.
A pediatric triage tool is needed during times of resource scarcity to optimize critical care utilization. This study compares the modified sequential organ failure assessment score (M-SOFA), the Pediatric Early Warning System (PEWS) score, the Pediatric Risk of Admission Score II (PRISA-II), and physician judgment to predict the need for pediatric intensive care unit (PICU) interventions. ⋯ No score had a clinically acceptable discriminate ability to predict patients who required a PICU intervention from those who did not. Physician judgment outperformed all three triage scores.