American journal of disaster medicine
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Refugees in long-term camp-based settings are often provided health services through health systems parallel to national health systems. This article, through literature review, explores the question of health service delivery in the context of long-term refugee situations, examining in particular the impact on host national population. The objective is to identify data and themes in literature that shed light on the utilization of health services for refugees and host population. ⋯ Literature reports varied impacts of refugee hosting on host national population. The need for a contextual approach to understand the impact of refugee hosting is indicated through these findings. Some studies found that refugee hosting improved the quality and accessibility of health services and, in some cases, health outcomes for host national population; however, the data supporting integrating health services for refugees and host population are limited, and both reduce the strength of the integration argument. The overall body of evidence to reach conclusions on what is the ideal model of health service delivery for refugees and host population is limited. Improved data collection and analysis of utilization patterns for refugees and host population could strengthen program and policy design in this area.
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The purpose of this study was to describe the impact of the 2009 H1N1 influenza pandemic on a pediatric emergency department (ED) at a freestanding children's hospital in the summer and fall of 2009. ⋯ The 2009 H1N1 influenza pandemic resulted in unprecedented patient volumes in this pediatric ED; however, patient acuity (based on admission rate) for patients with ILI was lower than patients with non-ILI. Pandemic influenza can overwhelm emergency care resources, even when the overall severity of illness is relatively low.
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The complexities and challenges for healthcare providers and their efforts to provide fundamental basic items to meet the logistical demands of an influenza pandemic are discussed in this article. The supply chain, planning, and alternatives for inevitable shortages are some of the considerations associated with this emergency mass critical care situation. The planning process and support for such events are discussed in detail with several recommendations obtained from the literature and the experience from recent mass casualty incidents (MCIs). ⋯ Resources highlighted within the model include allocation and use of work force, bed space, intensive care unit assets, ventilators, personal protective equipment, and oxygen. The third step is using the model to discuss in detail possible workarounds, suitable substitutes, and resource allocation. An examination is also made of the ethics surrounding palliative care within the construction of an MCI and the factors that will inevitably determine rationing and prioritizing of these critical assets to palliative care patients.
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Recent evidence demonstrates that emergency department (ED) and inpatient hospital crowding contributes to unsafe patient care. The blizzards of 2010 produced conditions that prohibited the safe discharge of admitted inpatients and were identified as a major factor in crowding of the ED at Howard County General Hospital (HCGH). At one point, admitted patients occupied 35 of the 36 treatment beds in the ED. ⋯ During this call, HCFR and HCGH also coordinated the emergency transport of an interventional cardiologist through the blizzard to HCGH to perform emergency cardiac catheterization. At the end of the operational period, the ED had regained all but four beds pending inpatient admission. These efforts fortified a strong partnership between a community hospital and local fire department to facilitate the expeditious discharge and disposition of inpatients during the blizzards of 2010 to decrease crowding.