Community pharmacies were underutilized as vaccination locations during the 2009 H1N1 pandemic. Since that time, community pharmacies are a common location for seasonal influenza vaccinations with approximately one-third of adults now getting vaccinated at a pharmacy. Leveraging community pharmacies to vaccinate during a pandemic such as pandemic influenza or the current coronavirus disease (COVID-19) pandemic will result in a more timely and comprehensive public health response. The purpose of this article is to summarize the results of a strategic planning meeting held in 2017 that focused on operationalizing pandemic influenza vaccinations at a regional supermarket chain pharmacy. Participating in the planning session from the supermarket chain were organizational experts in pharmacy clinical programs, managed care, operations leadership, supply chain, information technology, loss prevention, marketing, and compliance. Additionally, experts from the county and state departments of health and university faculty collaborated in the planning session. Topics addressed included (1) establishing a memorandum of understanding with the state, (2) developing an internal emergency response plan, (3) scaling the pandemic response, (4) considerations for pharmacy locations, (5) staffing for pandemic response, (6) pandemic vaccine-specific training, (7) pharmacy workflow, (8) billing considerations, (9) documentation, (10) supplies and equipment, (11) vaccine supply chain, (12) communications, and (13) security and crowd control. Information from this planning session may be valuable to community pharmacies across the nation that seek to participate in COVID-19 pandemic vaccinations.

Our hospital is one of the tertiary care hospitals in Oman receiving coronavirus disease (COVID-19; C19) patients. To meet the expected surge of patients, a number of changes was made to the emergency department (ED), especially regarding capacity building and patient flow. At first, few changes were made to the main ED, which mainly includes the addition of a COVID suspect room with the use of a separate resuscitation area. The major drawback of the abovementioned system was the inability to see more than 2 patients simultaneously. A later separate COVID emergency department (CED) was used. In the CED, pending admissions was the major problem, as the C19 ward and C19 intensive care unit were becoming full; this problem was solved through central command help. In the normal ED, the main problem was the presentation of C19-positive patients sometimes hiding their symptoms and reaching inside the main ED, exposing the staff and patients. In order to combat this problem, all patients with an acute respiratory problem, even if C19 is not suspected, were taken to the corner cubicle. In this report, the changes made in the ED to combat C19 spread are discussed.

One strategy for the containment of a pandemic is mass testing. Magen David Adom (MDA), the Israeli National Emergency Medical Services (EMS) Organization undertook this mission by operating a nationwide series of drive-through testing complexes. The objective of this study is to learn lessons from an analysis of these centers. Data from 198 stationary and mobile drive-through complexes from March 20, 2020, through October 17, 2020, were analyzed for temporal and geographic factors, and cost. Also, an operational improvement program was implemented and analyzed. A total of 931,074 patients were sampled in the MDA drive-through system: 46.9% in stationary complexes, and 53.1% in mobile complexes. The optimized cost per patient of home testing was estimated at 74.5 USD compared with 6.55 USD in the drive-through centers. An operational improvement program lowered the total sampling time from 128 s/patient to 98 s and decreased the total cost per patient from 6.55 USD to 6.27 USD. The EMS led drive-through complexes were cost-effective and efficient in performing large numbers of viral tests, especially when compared with home testing. Established concepts in clinical operations should be implemented to increase the number of persons that can be tested and decrease cost.

The coronavirus disease 2019 (COVID-19) pandemic is putting health-care systems under unprecedented stress to accommodate unexpected numbers of patients forcing a quick re-organization. This article describes the staff management experience of a third level referral hospital in the city of Madrid, Spain, one of the cities and hospitals with the largest number of COVID-19 cases.

A newly created COVID-19-specific clinical management unit (CMU) coordinated all clinical departments and conducted real-time assessments of the availability and needs of medical staff, alongside the hospital’s general management board. The CMU was able to (i) redeploy up to 285 physicians every week to bolster medical care in COVID-19 wards and forecast medical staff requirements for the upcoming week so all departments could organize their work while coping with COVID-19 needs, (ii) overview all clinical activities conducted in a medicalized hotel, and (iii) recruit a team of roughly 90 volunteer medical students to accelerate data collection and evidence generation.

The main advantage of a CMU composed by a member of every job category—its ability to generate rapid, locally adapted responses to unexpected challenges—made it perfect for the unprecedented increase in health-care need generated by the COVID-19 pandemic.

There is an ongoing and established need for humanitarian training and professionalization. The coronavirus disease 2019 (COVID-19) pandemic disrupted training programs designed to accomplish this goal, including the Humanitarian Response Intensive Course, which includes a 3-d immersive simulation to prepare humanitarian workers for future field work. To provide program continuity, the 3-d simulation was quickly adapted to a virtual format using a combination of video conferencing, short messaging service, and cloud-based file storage software. Participants were geographically dispersed and participated virtually. Learning objectives were preserved, while some components not amenable to a virtual format were removed.

A virtual humanitarian training simulation is a feasible, acceptable, and affordable alternative to an in-person simulation. Participants were engaged and experienced minimal technological disruptions. The majority of students believed the format met or exceeded expectations. However, feedback also emphasized the importance of providing sufficient time for team collaboration and deliverable preparation in the simulation schedule. The virtual format was more affordable than the traditional in-person simulation, and diverse expert faculty who could not have attended in-person were able to participate. This format could be used to overcome other barriers to in-person simulation training, including geographic, financial, time, or security.

Nurses play an important role during disaster response and recovery. Few tools are available to assess the relative competence of nurses in disaster. This study aimed to develop, test, and evaluate a disaster nursing competency scale. This was an exploratory mixed methods study. In the qualitative phase, 35 Iranian nurses and managers with experience in disaster relief were asked about the skills they need to respond effectively to a disaster event. From the qualitative data, a 50-item questionnaire was developed. In the quantitative phase, exploratory factor analysis was conducted with 400 samples followed by a test-retest reliability assessment with 30 nurses. The developed and validated instrument was applied to 200 nurses in Iran to assess their competency. From content analysis of the qualitative data, 5 main themes emerged. In the quantitative phase, exploratory factor analysis loaded 50 items into 4 domains named management, legal and ethical, specific personal, and technical competence. Use of the tool showed that nurses estimated their competence overall at 70.28%. Findings demonstrate the necessity for new domains in disaster nursing competencies; which may be applicable as a useful tool and guideline to improve nursing education and practice.

The coronavirus disease (COVID-19) pandemic has stressed the US health care system in unprecedented ways. In March and April 2020, emergency departments (EDs) throughout New York City experienced high volumes and acuity related to the pandemic. Here, we present a structured after-action report of a coalition of 9 EDs within a hospital system in the New York City metropolitan area, with an emphasis on best practices developed during the prolonged surge as well as specific opportunities for growth. We report our experience in 6 key areas using a framework built around lessons learned. This report represents the most salient concepts related to our institutional after-action report, and those seemingly most relevant to our peer institutions dealing with similar circumstances.

The importance of MCI organization and training was highlighted by the events of September 11, 2001. Training focuses on the management of physical injuries caused by a single traumatic event over a well-defined, relatively short timeframe. MCI management is integrated into surgical and trauma training, with disaster management training involving the emergency services, law enforcement, and state infrastructure agencies. The COVID-19 pandemic revealed gaps in the preparedness of nation states and global partners in disaster management. The questions that arose include ‘has training really prepared us for an actual emergency,’ ‘what changes need to be made to training to make it more effective,’ and ‘who else should training be extended to?’ This article focuses on the importance of involving multiple sectors in mass casualty training and asks whether greater involvement of non-medical agencies and the public, in operational drills might improve preparedness for global events such as the COVID-19 pandemic.

Modeling studies indicate that the closure of schools during the coronavirus disease (COVID-19) pandemic may not be well grounded for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as evidences indicate that children are less affected by this virus, and the clinical attack rates in the 0–19 age group are low. Experts also opine that school closures might have negative effects on the scholastic abilities of children and also an adverse impact on the economy and health care system, considering the responsibilities conferred upon the parents. Also, in a developing country like India, it is difficult for the rural population to afford distance online learning, which brings into importance the reopening of schools in a safe environment to avoid adversities such as increased drop-outs in the upcoming academic year, loss of in-person benefits such as mid-day meal scheme. This study highlights a field experience in relation to readiness assessment of a rural school in the Jodhpur district of Rajasthan, India, for a safe reopening to accept students in a safe and conducive atmosphere, which shall help prevent transmission of the virus in the schools among the children. In this regard, an indigenous readiness checklist has been developed to achieve the purpose, which assesses the readiness in 3 domains: (1) procedural readiness; (2) supplies, sanitation, and infrastructure-related; and (3) education and training.

During the COVID-19 pandemic, access to addiction treatment has plummeted. At the same time, patients with opioid use disorder are at higher risk of COVID-19 infection and experience worse outcomes. The Baltimore Convention Center Field Hospital (BCCFH), a state-run COVID-19 disaster hospital operated by Johns Hopkins Medicine and the University of Maryland Medical System, continues to operate 14 months into the pandemic to serve as an overflow unit for the state’s hospitals. BCCFH staff observed the demand for opioid use disorder care and developed admission criteria, a pharmacy formulary, and case management procedures to meet this need. This article describes generalized lessons from the BCCFH experience treating substance use disorder during a pandemic.

Due to the coronavirus disease 2019 (COVID-19) pandemic, there is currently a need for accurate, rapid, and easy-to-administer diagnostic tools to help communities manage local outbreaks and assess the spread of disease. The use of artificial intelligence within the domain of breath analysis techniques has shown to have potential in diagnosing a variety of diseases, such as cancer and lung disease, by analyzing volatile organic compounds (VOCs) in exhaled breath. This combined with their rapid, easy-to-use, and noninvasive nature makes them a good candidate for use in diagnosing COVID-19 in large scale public health operations. However, there remains issues with their implementation when it comes to the infrastructure currently available to support their use on a broad scale. This includes issues of standardization, and whether or not a characteristic VOC pattern can be identified for COVID-19. Despite these difficulties, breathalyzers offer potential to assist in pandemic responses and their use should be investigated.

During emergency responses, public health leaders frequently serve in incident management roles that differ from their routine job functions. Leaders’ familiarity with incident management principles and functions can influence response outcomes. Therefore, training and exercises in incident management are often required for public health leaders. To describe existing methods of incident management training and exercises in the literature, we queried 6 English language databases and found 786 relevant articles. Five themes emerged: (1) experiential learning as an established approach to foster engaging and interactive learning environments and optimize training design; (2) technology-aided decision support tools are increasingly common for crisis decision-making; (3) integration of leadership training in the education continuum is needed for developing public health response leaders; (4) equal emphasis on competency and character is needed for developing capable and adaptable leaders; and (5) consistent evaluation methodologies and metrics are needed to assess the effectiveness of educational interventions.

These findings offer important strategic and practical considerations for improving the design and delivery of educational interventions to develop public health emergency response leaders. This review and ongoing real-world events could facilitate further exploration of current practices, emerging trends, and challenges for continuous improvements in developing public health emergency response leaders.

In March 2020, concurrently with the outbreak of coronavirus disease 2019 (COVID-19) in Iran, the rate of alcohol poisoning was unexpectedly increased in the country. This study has attempted to make an overall description and analysis of this phenomenon by collecting credible data from the field, news, and reports published by the emergency centers and the Iranian Ministry of Health. The investigations showed that in May 20, 2020, more than 6150 people have been affected by methanol poisoning from whom 804 deaths have been reported. A major cause of the increased rate of alcohol poisoning in this period was actually the illusion that alcohol could eliminate the coronaviruses having entered the body. It is of utmost importance that all mass media try to dismiss the cultural, religious, and political considerations and prepare convincing programs to openly discuss the side-effects of forged alcohol consumption with the public, especially with the youth. It must be clearly specified that “consuming alcohol cannot help prevent COVID-19.”

Before coronavirus disease 2019 (COVID-19), few hospitals had fully tested emergency surge plans. Uncertainty in the timing and degree of surge complicates planning efforts, putting hospitals at risk of being overwhelmed. Many lack access to hospital-specific, data-driven projections of future patient demand to guide operational planning. Our hospital experienced one of the largest surges in New England. We developed statistical models to project hospitalizations during the first wave of the pandemic. We describe how we used these models to meet key planning objectives. To build the models successfully, we emphasize the criticality of having a team that combines data scientists with frontline operational and clinical leadership. While modeling was a cornerstone of our response, models currently available to most hospitals are built outside of their institution and are difficult to translate to their environment for operational planning. Creating data-driven, hospital-specific, and operationally relevant surge targets and activation triggers should be a major objective of all health systems.

Americium is a man-made metal produced in very small quantities in nuclear reactors. Americium-241 is one of the radioactive isotopes of americium and has commercial applications, including use in smoke detectors. This is a case report of an occupational inhalation of americium-241, treated with both effective external decontamination and the use of diethylenetriamine pentaacetate to promote decorporation. This experience is significant because of the potential for americium or similar radionuclides to be used in “dirty” bombs or other radiological dispersion devices to cause large-scale radioactive contamination.

Emergency evacuation during disasters may have significant health impacts on vulnerable populations. The Japanese Government issued evacuation orders for surrounding residents of the Fukushima Daiichi nuclear power plant (FDNPP) immediately after the March 11, 2011, nuclear accident. Little is known of difficulties associated with the disaster-specific evacuation from health care facilities located in this area. Among the 338 patients hospitalized at Futaba Hospital, located 4.6 km west of FDNPP, at the time of the accident, 39 patients (11.5%), predominantly critically ill patients who were bedridden or disabled, died before the evacuation was completed. The shortage of hospital staff and disruption of infrastructure resulted in a lack of adequate care provision, such as infusion therapy or sputum suctioning, leading to premature death of some hospitalized patients during the emergency hospital evacuation. As hospital evacuation is sometimes unavoidable during disasters, potential health impacts of hospital evacuation should be recognized and reflected in disaster preparedness plans.

The COVID-19 pandemic has demonstrated that emergency departments (EDs) need to reorganize their operations rapidly. This study investigated the impact of the pandemic on structural and logistical issues at EDs and the measures taken. Belgian EDs were surveyed on the implemented changes at the start of the pandemic in relation to the 4 S’s in disaster medicine: Structure, Staff, Supplies, and System. The study demonstrated that Belgian EDs felt largely unprepared for this pandemic, but nevertheless dynamically restructured their organization. A 46% increase in ED beds was created in different types of structures and more than 50% of all ED beds were reserved for COVID-19 care, but overall the number of patient presentations dropped by 29%. EDs deployed extra personnel, additional training, and psychological support. More than 50% reported an acute shortage of personal protective equipment, and several reported a shortage of ventilatory equipment and medications.