The aim of this study was to determine the extent that appropriate personal protective equipment (PPE), per Centers for Disease Control and Prevention (CDC) guidance, was used during the coronavirus diseases 2019 (COVID-19) pandemic by health-care personnel (HCP) in Louisiana in 5 clinical settings.

An online questionnaire was distributed to the LA Nursery registry. Appropriate use of PPE in each of the 5 clinical scenarios was defined by the authors based on CDC guidelines. The scenarios ranged from communal hospital space to carrying out aerosol generating procedures (AGPs). A total of 1760 HCP participated between June and July 2020.

The average adherence in LA was lowest for the scenario of carrying out AGPs at 39.5% compliance and highest for the scenario of patient contact when COVID-19 not suspected at 82.8% compliance. Adherence among parishes varied widely. Commentary to suggest a shortage of PPE supply and the practice of re-using PPE was strong.

Use of appropriate PPE varied by setting. It was higher in scenarios where only face masks (or respirators) were the standard (ie, community hospital or when COVID-19 not suspected) and lower in scenarios where additional PPE (eg, gloves, eye protection, and isolation gown) was required.

As coronavirus disease 2019 (COVID-19) spread, efforts were made to preserve resources for the anticipated surge of COVID-19 patients in British Columbia, Canada. However, the relationship between COVID-19 hospitalizations and access to cancer surgery is unclear. In this project, we analyze the impact of COVID-19 patient volumes on wait time for cancer surgery.

We conducted a retrospective study using population-based datasets of regional surgical wait times and COVID-19 patient volumes. Weekly median wait times for urgent, nonurgent, cancer, and noncancer surgeries, and maximum volumes of hospitalized patients with COVID-19 were studied. The results were qualitatively analyzed.

A sustained association between weekly median wait time for priority and other cancer surgeries and increase hospital COVID-19 patient volumes was not qualitatively discernable. In response to the first phase of COVID-19 patient volumes, relative to pre-COVID-19 pandemic levels, wait time were shortened for urgent cancer surgery but increased for nonurgent surgeries. During the second phase, for all diagnostic groups, wait times returned to pre-COVID-19 pandemic levels. During the third phase, wait times for all surgeries increased.

Cancer surgery access may have been influenced by other factors, such as policy directives and local resource issues, independent of hospitalized COVID-19 patient volumes. The initial access limitations gradually improved with provincial and institutional resilience, and vaccine rollout.

The aim of this study was to investigate the long-term outcome of quality of life (QOL) in the lower-limb amputees 10 years after the 2008 Sichuan earthquake.

In the cross-sectional study, 66 lower-limb amputees were recruited. The prosthetics-related QOL was assessed using the Prosthetic Evaluation Questionnaire (PEQ) in terms of the scales of utility, appearance, sounds, residual limb health, perceived response, frustration, social burden, ambulation, and well-being. The score of each PEQ subscale was calculated and compared among the cohorts with different demographic characteristics.

The PEQ scores showed that the scales of sounds, residual limb health, and frustration were still low in the lower-limb amputees 10 years after the 2008 Sichuan earthquake. The comparison of PEQ scales among cohorts with different demographic characteristics indicated that the potential demographic risk factors, namely, age, marital status, educational level, living independence, and comorbidity, were associated with prosthesis-related QOL.

The prosthesis-related QOL of the lower-limb amputees 10 years after the 2008 Sichuan earthquake has been partly documented in this study. The potential demographic risk factors associated with QOL of amputees were also identified. These findings could enhance the understanding of prosthesis-related QOL of lower-limb amputees sustained in an earthquake and facilitate the optimization of post-disaster rehabilitation strategies.

Obesity is a risk factor for various diseases and can affect the disease course. Studies have shown detrimental effects of obesity on patients affected with SARS-CoV-2 including increased hospitalization and more severe disease. This study aims to investigate the effects of obesity on symptom duration in patients with COVID-19, and also explore the possibility of using BMI as a predictor of symptom duration in outpatient settings.

Patients diagnosed with COVID-19 between June and October 2020, who had no other comorbidities, and were planned to receive treatment in the outpatient setting were enrolled in the study. Duration of the symptoms was determined based on participants’ self-report of their symptoms. Linear regression was used to create predictive models based on participants’ BMI, age, sex, disease presentation, and their self-reported symptom duration.

A total of 210 patients were included in the final analysis. Patients with higher BMI had significantly longer symptom duration. Linear regression models showed highest correlation between BMI and symptom duration compared to other covariates.

Low error in predictions and high coverage of data variability showed BMI can be used as a predictive factor for symptom duration in COVID-19 patients treated in outpatient settings.

The aim of this study was to develop and evaluate a pre-deployment sequestration (PDS) protocol to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases on board the USS Ronald Reagan (CVN-76).

The USS Ronald Reagan includes a crew of approximately 3000 Sailors and an embarked Air Wing of 2000 personnel. The PDS was conducted in 3 waves of 14-day strict quarantines during the months of April and May 2020. Sailors were cleared to board the ship with 2 negative reverse transcriptase polymerase chain reaction (rtPCR) tests at days 14 and 16. The ship was sanitized before Wave 1 boarding.

From March 1, 2020, through May 31, 2020, a total of 51 SARS-CoV-2 positive cases were detected. During the 3 waves of PDS, 28 Sailors were found to be positive on exit testing (14, 11, and 3, respectively); no cases were found among the Air Wing. During the first 90 days at sea, no SARS-CoV-2 cases were detected among any of the embarked personnel.

Although resource-intensive, the PDS protocol implemented for USS Ronald Reagan resulted in a coronavirus disease 2019 (COVID-19)-free ship during a global pandemic with unprecedented scope. Elements of this pandemic PDS protocol may be useful in other highly risk-averse environments with no tolerance for COVID-19 infections.

To describe school district preparedness for school closures and other relevant strategies before the coronavirus disease 2019 (COVID-19) pandemic.

A stratified random sample of 957 public school districts from the 50 US states and the District of Columbia were surveyed between October 2015 and August 2016. The response rates for the questionnaires were as follows: Healthy and Safe School Environment, Crisis Preparedness Module (60%; N = 572), Nutrition Services (63%; N = 599), and Health Services (64%; N = 613). Data were analyzed using descriptive and regression techniques.

Most school districts had procedures that would facilitate the implementation of school closures (88.7%). Fewer districts had plans for ensuring continuity of education (43.0%) or feeding students during closure (33.8%). The prevalence of continuity of education plans was lower in the Midwest than the Northeast (adjusted prevalence ratio [aPR] = 0.68; 95% confidence interval [CI]: 0.51-0.90). Presence of plans for feeding students was higher in high-poverty than low-poverty districts (aPR = 1.41; 95% CI: 1.01-1.99) and in large districts than small districts (aPR = 2.06; 95% CI: 1.37-3.09).

Understanding factors associated with having comprehensive emergency plans could help decision makers to target assistance during the current COVID-19 pandemic and for future planning purposes.

Public health and emergency management agencies play a critical role in addressing the needs of vulnerable populations in preparation for and in response to emergencies. Identifying and leveraging community assets is a way to address such needs. This study focuses on the development of a process and tools to engage community leaders in sharing their knowledge about their community characteristics and assets useful for emergency planning.

We conducted interviews with community leaders across five study sites with the goal of understanding what type of local knowledge community leaders are able to share in regard to emergency preparedness. Based on the interview results we developed and tested a mobile application as a mobile friendly directory of community assets.

We identified two main types of local knowledge about community assets for emergency preparedness: communication-based and trust-based local knowledge. We created an application to facilitate the sharing of such knowledge. Community leaders were able to share local knowledge across four areas: communication-based assets, trust-based assets, spatial-based assets and personal-preparedness assets.

Community leaders’ engagement in preparedness efforts is important to identify community assets that can be leveraged to address the needs of the most vulnerable segments of a community.

Active shooter incidents (ASI) have continued to increase over the years, with the majority of attacks occurring in the workplace. Workplace violence in the hospital setting is a growing concern in the emergency department (ED). While ASI are inherently unpredictable by nature, it is prudent to be prepared for these scenarios in the hospital to prevent fatalities. The goal of this study is to access the level of familiarity of emergency department staff with ASI hospital policy and response protocol.

A survey of ED employees was distributed using the Qualtrics® platform via an electronic link. The study was approved by the University of Central Florida College of Medicine’s IRB.

Only 10% had participated in an ASI drill in the past year. Personnel who answered “no” to the question, To your knowledge, is there a hospital-based emergency action plan in the event of ASI?, were significantly more likely to feel unprepared for an ASI (P < 0.0001). Those who did not receive training for a hospital-based emergency action plan were similarly less likely to feel prepared (P = 0.0002).

Most ED providers in the survey reported feeling unprepared to handle an ASI in the emergency department. This study underscores the need to implement regular training on ASIs for ED staff.

This study aims to explore a public volunteer’s hospital response model in natural disasters in Iran.

This study employed grounded theory using the Strauss and Corbin 2008 method and data analysis was carried out in three steps, namely open, axial, and selective coding. The present qualitative study was done using semi-structured interviews with 36 participants who were on two levels and with different experiences in responding to emergencies and disasters as “public volunteers” and “experts”. National and local experts were comprised of professors in the field of disaster management, hospital managers, Red Crescent experts, staff and managers of Iran Ministry of Health and Medical Education.

The main concept of the paradigm model was “policy gap and inefficiency” in the management of public volunteers, which was rooted in political factions, ethnicity, regulations, and elites. The policy gap and inefficiency led to chaos and “crises over crises.” Overcoming the policy gap will result in hospital disaster resilience. Meanwhile, the model covered the causal, contextual, and intervening conditions, strategies, and consequences in relation to the public volunteers’ hospital response phase.

The current public volunteers’ hospital in Iran suffered from the lack of a coherent, comprehensive, and forward-looking plan for their response. The most important beneficiaries of this paradigm model will be for health policy-makers, to clarify the main culprits of creating policy gap and inefficiency in Iran and other countries with a similar context. It can guide the decision-makings in upstream documents on the public volunteers. Further research should carried out to improve the understanding of the supportive legal framework, building the culture of volunteering, and enhancing volunteers’ retention rate.

This work aimed to identify, appraise, and summarize existing knowledge about oral health interventions in the context of natural disasters and verify the main research gaps.

We searched in PubMed (National Library of Medicine, Maryland, USA), EMBASE (Elsevier, Amsterdam, Netherlands) and Epistemonikos (Epistemonikos Foundation, Santiago, Chile) until 2021 for primary studies and systematic reviews, assessing any oral health intervention in the context of natural disasters. The interventions were classified according to Cochrane Effective Practice and Organization of Care (EPOC) categories, and the type of natural disaster was defined according to the classification by the Centre for Research on the Epidemiology of Disasters (CRED).

We assessed a total of 19 studies (majorly in Japan, n = 8), all performed in the context of an earthquake or mixed natural disasters (earthquake and tsunami). Regarding interventions, 12 studies reported a promotional/ preventive intervention, with oral examination being the most frequent. 7 studies reported therapeutic interventions, mainly related to emergency management of fractures and injuries.

The evidence accessed in our study was limited, highlighting the need for further research to focus on different oral health care interventions and outcomes in the context of different natural disasters, thus enhancing the formulation and implementation of recommendations and protocols worldwide.

To provide standardized recommendations for the emergency department (ED) response to chemical, biological, radiological, and nuclear (CBRN) events by combining the human factors/ergonomics method of hierarchical task analysis with the theoretical framework for Work as Imagined versus Work as Done.

Document analyses were used to represent CBRN response operational procedures. Semi-structured interviews using scenario cards were carried out with 57 first receivers (ED staff) to represent CBRN practice at 2 acute hospitals in England.

Variability existed in general organizational responsibilities associated with the CBRN response. Variability was further evident in top level CBRN tasks and CBRN phases at both EDs. Operational procedures focused on tasks such as documentation, checking, and timing. CBRN practice focused on patient needs through assessment, treatment, and diagnosis.

The findings provide top-down and bottom-up insights to enhance the ED CBRN response through standardization. The standardized CBRN action card template embeds the choice approach to standardization. The standardized CBRN framework implements the streamlined categorization of CBRN phases. Work as Imagined versus Work as Done is a useful theoretical framework to unpack a complex sociotechnical system, and hierarchical task analysis is an effective system mapping tool in health care.

An understanding of emergency nurses’ roles, challenges, and preparedness in the context of armed conflict is necessary to capture in-depth insights into this specialty and their preparational needs when working in these unique environments. Unfortunately, the evidence about emergency nurses’ work in the context of armed conflict is scant.

Semi-structured interviews were conducted with 23 participants and analyzed using qualitative content analysis. The COREQ guideline for reporting qualitative research was followed.

The emergency nurses’ roles, challenges, and preparedness in hospitals in the context of armed conflict were explored in detail. The main challenges that these nurses faced included poor orientation, access block, and communication barriers. Various perspectives about preparation, including education, training, and strategies for preparing emergency nurses were identified. The most striking findings in these settings were the diversity of armed conflict injuries, clinical profiles of patients, triage of mass casualties, trauma care, surge capacity, orientation, communication, and strategies for preparing nurses.

This study provided an exploration of the scope of emergency nurses’ roles, and how they were prepared and expected to function across multiple hospitals in armed conflict areas. The resultant snapshot of their experiences, challenges, and responsibilities provides an informative resource and outlines essential information for future emergency nursing workforce preparedness. There is a broad range of preparational courses being undertaken by emergency nurses to work effectively in settings of armed conflict; however, required education and training should be carefully planned according to their actual roles and responsibilities in these settings.

The study aimed to identify the factors that influence the disaster preparedness of hospitals and validate an evaluation framework to assess hospital disaster preparedness (HDP) capability in the Eastern Province of Saudi Arabia.

A cross-sectional survey of all hospitals (n = 72) in the Eastern Region of Saudi Arabia was conducted. A factor analysis method was used to identify common factors and validate the evaluation framework to assess HDP capacity.

Sixty-three (63) hospitals responded to the survey. A 3-factor structure was identified as key predicators of HDP capacity. The first factor was the most highly weighted factor, which included education and training (0.849), monitoring and assessing HDP (0.723), disaster planning (0.721), and command and control (0.713). The second factor included surge capacity (0.708), triage system (0.844), post-disaster recovery (0.809), and communication (0.678). The third factor represented safety and security (0.638) as well as logistics, equipment, and supplies (0.766).

The identified 3-factor structure provides an innovative approach to assist the operationalization of the concept of HDP capacity building and service improvement, as well as serve as a groundwork to further develop instrument for assessing HDP in future studies.