Though children comprise a large percentage of the population and are uniquely vulnerable to disasters, pediatric considerations are often omitted from regional and hospital-based emergency preparedness. Children’s absence is particularly notable in hazard vulnerability analyses (HVAs), a commonly used tool that allows emergency managers to identify a hazard’s impact, probability of occurrence, and previous mitigation efforts. This paper introduces a new pediatric-specific HVA that provides emergency managers with a quantifiable means to determine how a hazard might affect children within a given region, taking into account existing preparedness most relevant to children’s safety. Impact and preparedness categories within the pediatric-specific HVA incorporate age-based equipment and care needs, long-term developmental and mental health consequences, and the hospital and community functions most necessary for supporting children during disasters. The HVA allows emergency managers to create a more comprehensive assessment of their pediatric populations and preparatory requirements.

This paper examines the career trajectories of new health policy elites in the American federal government, identifying areas of expertise, partisan alignments, relationships to interest groups, and institutional constraints. We demonstrate that, in both the American and French cases, policy elites who have risen through prestigious educational institutions and undertaken extensive professionalization in government, have in fact developed comparable characteristics that blend broad knowledge of social, institutional, and partisan issues with technical skills. We argue that, benefiting from extensive experience in the back offices of power, deeply entrenched in the health policy sector, and promoting a programmatic reform agenda that reaffirms the regulatory powers of government, the new American health policy elites worked behind the scenes to draft and implement the final ACA legislation. Their ambitious, far-reaching reform effort succeeded where many advocates of comprehensive reform had failed, anchoring the political and institutional framework of the U.S. health care system.

A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.