The effect of filtering face piece grade 2 (FFP2) masks for infection prevention is essential in health care systems; however, it depends on supply chains. Efficient methods to reprocess FFP2 masks may be needed in disasters. Therefore, different UV-C irradiation schemes for bacterial decontamination of used FFP2 masks were investigated.

Seventy-eight masks were irradiated with UV light for durations between 3 and 120 seconds and subsequently analyzed for the presence of viable bacteria on the inside. Ten masks served as the control group. Irradiation on the inside of the masks reduced bacteria in proportion to the dose, with an almost complete decontamination after 30 seconds. Outside irradiation reduced the quantity of colonies without time-dependent effects. Both sides of irradiation for a cumulated 30 seconds or more showed almost complete decontamination.

Overall, this study suggests that standardized UV irradiation schemes with treatment to both sides might be an efficient and effective method for FFP2 mask decontamination in times of insufficient supplies.

The high prevalence of fentanyl in the illicit drug supply has generated concern among first responders regarding occupational exposure. Social media sharing of unconfirmed first responder overdoses after brief exposure to fentanyl may be contributing to an inappropriate risk perception of brief dermal fentanyl exposure. This case details a dermal exposure to a large dose of analytically confirmed pharmaceutical fentanyl (fentanyl citrate, 10 microgram fentanyl base per ml), over a large skin surface area. Additionally, the exposure occurred at a site with some skin barrier compromise, a factor that can increase fentanyl absorption. The patient underwent appropriate decontamination and underwent a brief medical assessment with no clinical effects of opioid exposure observed. This information is of value to first responders and other health care workers who are at risk of occupational fentanyl exposure. Findings are consistent with in vitro and ex vivo data supporting low risk of rapid absorption after brief dermal fentanyl exposure.

Firefighting service is known to involve high rates of exposure to potentially traumatic situations, and research on mental health in firefighting populations is of critical importance in understanding the impact of occupational exposure. To date, the literature concerning prevalence of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) has not distinguished between symptomology associated routine duty-related exposure and exposure to large-scale disaster. The present systematic review synthesizes a heterogeneous cross-national literature on large-scale disaster exposure in firefighters and provides support for the hypothesis that the prevalence of PTSD, major depressive disorder, and anxiety disorders are elevated in firefighters compared with rates observed in the general population. In addition, we conducted narrative synthesis concerning several commonly assessed predictive factors for disorder and found that sociodemographic factors appear to bear a weak relationship to mental disorder, while incident-related factors, such as severity and duration of disaster exposure, bear a stronger and more consistent relationship to the development of PTSD and depression in cross-national samples. Future work should expand on these preliminary findings to better understand the impact of disaster exposure in firefighting personnel.

On October 7, 2016, Hurricane Matthew traveled along the coasts of Florida, Georgia, and South Carolina causing flooding and power outages. The Georgia Department of Public Health (DPH) developed the Web-based Responder Safety, Tracking, and Resilience (R-STaR) system to monitor the health and safety of public health responders and to inform disaster response planning for Hurricane Matthew. Using R-STaR, responders (n = 126) were e-mailed a daily survey while deployed to document injuries or harmful exposures and a post-deployment survey on their post-deployment health and satisfaction with using R-STaR. DPH epidemiologists contacted responders reporting injuries or exposures to determine the need for medical care. Frequencies were tabulated for quantitative survey responses, and qualitative data were summarized into key themes. Five percent (6/126) of responders reported injuries, and 81% (43/53) found R-STaR easy to use. Suggestions for R-STaR improvement included improving accessibility using mobile platforms and conducting pre-event training of responders on R-STaR. Lessons learned from R-STaR development and evaluation can inform the development and improvement of responder health surveillance systems at other local and state health departments and disaster and emergency response agencies. (Disaster Med Public Health Preparedness. 2019;13:74–81).

A latent tuberculosis infection (LTBI) prevalence survey was conducted using tuberculin skin test (TST) and Quantiferon test (QFT) in 1218 healthcare workers (HCWs) in Medellín, Colombia. In order to improve the prevalence estimates, a latent class model was built using a Bayesian approach with informative priors on the sensitivity and specificity of the TST. The proportion of concordant results (TST+,QFT+) was 41% and the discordant results contributed 27%. The marginal estimate of the prevalence P(LTBI+) was 62·1% [95% credible interval (CrI) 53·0–68·2]. The probability of LTBI+ given positive results for both tests was 99·6% (95% CrI 98·1–99·9). Sensitivity was 88·5 for TST and 74·3 for QFT, and specificity was 87·8 for TST and 97·6 for QFT. A high LTBI prevalence was found in HCWs with time-accumulated exposure in hospitals that lack control plans. In a context of intermediate tuberculosis (TB) incidence it is recommended to use only one test (either QFT or TST) in prevalence surveys or as pre-employment tests. Results will be useful to help implement TB infection control plans in hospitals where HCWs may be repeatedly exposed to unnoticed TB patients, and to inform the design of TB control policies.

As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population’s health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented. (Disaster Med Public Health Preparedness. 2015;9:558–567)

We simulated the frequency of tuberculosis infection in healthcare workers in order to classify the risk of TB transmission for nine hospitals in Medellín, Colombia. We used a risk assessment approach to estimate the average number of infections in three risk groups of a cohort of 1082 workers exposed to potentially infectious patients over 10- and 20-day periods. The risk level of the hospitals was classified according to TB prevalence: two of the hospitals were ranked as being of very high priority, six as high priority and one as low priority. Consistent results were obtained when the simulation was validated in two hospitals by studying 408 healthcare workers using interferon gamma release assays and tuberculin skin testing. The latent infection prevalence using laboratory tests was 41% [95% confidence interval (CI) 34·3–47·7] and 44% (95% CI 36·4–51·0) in those hospitals, and in the simulation, it was 40·7% (95% CI 32·3–49·0) and 36% (95% CI 27·9–44·0), respectively. Simulation of risk may be useful as a tool to classify local and regional hospitals according to their risk of nosocomial TB transmission, and to facilitate the design of hospital infection control plans.

Interventional cardiologists (ICs) are repeatedly exposed to scattered ionising radiationduring the cardiac procedures they perform, and radiation protection is an important issuefor these medical professionals. The use of radiation protection tools is particularlyrelevant to this population. SISERI (Système d’Information de la Surveillance del’Exposition aux Rayonnement Ionisants, that is, an information system for monitoringexposure to ionising radiation) is a register that stores personal dosimeter readings fordosimetric monitoring. This paper, based on data for a sample of French ICs from theO’CLOC epidemiological study, aims to provide an overview of the use of radiationprotection equipment and dosimetric devices reported by ICs in a specific questionnaire aswell as the dosimetric information found in the SISERI database for this population.Material and Methods − Annual information on interventional cardiology activity for theperiod from 01/01/2005 to 31/12/2009 was collected in an occupational questionnaire. ICswere asked to report the frequency in which they used individual dosimeter and radiationprotection tools (lead apron, thyroid shield, eyewear or face shield, ceiling-suspendedshield) as follows: never (0% of the time), occasionally (<50%), regularly (>50%), always (100%). We retrieved theirmedical radiation exposure information (monitored status and monthly effective doses) fromthe SISERI database for the period 2005−2009. Results – Information for 132 ICs (mean age in2005 = 46 ± 7 years) wasavailable. All ICs reported routine use of lead aprons, in contrast to their occasionaluse of lead eyewear or face shields. During the study period, 49% reported systematic useof personal dosimeters, and 21% more regular use. On the other hand, 18% never used adosimeter during this period. The SISTERI database included 92% of our population, 73% ofwhom had complete annual dose monitoring in SISERI (corresponding to at least 11 monthsper year of recorded data). Conclusion − ICs must improve their regular use ofradiation protection tools and systematic use of personal dosimeters. The SISERI databaseis an appropriate tool for flagging those medical professionals exposed to ionisingradiation. Better awareness of the importance of radiation protection rules in thispopulation, in particular, systematic dosimeter use, remains an important issue.

Introduction: Paramedics play an integral role in the response to and management of disasters and mass casualty events. Providing a core component of the front line response to disasters, paramedics potentially expose themselves to a variety of health and safety risks, including physical injury, death, communicable disease, and psychological effects. The health and safety risks to emergency service personnel were highlighted by the deaths of firefighters, paramedics, and police during the September 11, 2001, terrorist attacks, and the infection, illness, and deaths of paramedics and emergency health care staff during the severe acute respiratory syndrome outbreak in 2003.

Objective: Given that a willing and able prehospital workforce is a vital component of any successful response to a disaster situation, the present study explored paramedics' perception of risk and willingness to work, with a specific focus on identifying which type of disasters that paramedics associate with greater levels of fear, familiarity, and risk.

Methods: A total of 175 paramedics completed a survey ranking 40 disaster scenarios for levels of fear and familiarity.

Results: The results indicate that paramedics ranked nuclear and radiological events and outbreaks of new and highly infectious disasters highest for fear and unfamiliarity. This has implications for preparedness, education, and training.

(Disaster Med Public Health Preparedness. 2011;5:46-53)

In a Belgian wool-processing factory, living anthrax spores were found in raw goat hair and air dust, but confirmed anthrax cases had never been reported. Anthrax vaccines are not licensed nor recommended in Belgium. We conducted a B. anthracis seroprevalence study to investigate risk factors associated with positive serology and advise on protective measures. Overall 12·1% (8/66) employees were seropositive; 30% of persons processing raw goat hair and 20% of persons sorting raw goat hair were seropositive compared to 3% in less exposed jobs [adjusted prevalence ratio (aPR) 44·4, P=0·001; aPR 14·5, P=0·016, respectively). The number of masks used per day was protective (aPR 0·3, P=0·015). Results suggest a dose–response association for those processing raw goat hair. Host-related factors probably played a role as antibody response varied from person to person within an exposure group. Workers exposed to raw goat hair should be offered higher protection against anthrax and have access to anthrax vaccines.

Cette étude a eu pour but de déterminer la durée du port de la tenue ventilée TIVA au cours d’un exercice physique à la chaleur en fonction de l’atteinte de seuils physiologiques de sécurité. Cinq sujets volontaires équipés de la tenue ventilée TIVA ont effectué un exercice sur tapis roulant (3,5 km/h, 3 % de pente) en chambre thermoclimatique à 25, 35 et 45 °C d’une durée maximale de 2 h. La fréquence cardiaque, la température rectale (Tre) et la température cutanée moyenne (Tsk) ont été mesurées en continu. La déshydratation a été calculée par la perte de poids au cours de l’exercice. À 25 °C, il n’y a pas d’atteinte des seuils thermiques ou cardio-vasculaires mais il y a un risque de déshydratation si l’exercice se prolonge. Par contre pour les tests à 35 et 45 °C, la durée limite d’exposition (DLE) est limitée, pour le seuil de Tre à 39 °C, à 97  ±  29 et 69  ±  28 min, respectivement. Pour l’atteinte du seuil d’augmentation de la Tre de +1,5 °C, les DLE sont de 84  ±  38 min à 35 °C et de 57  ±  21 min à 45 °C. Les conditions à 35 °C et 45 °C conduisent à un stockage thermique (42,2  ±  22,9 W/m2 et 63,7  ±  29,4 W/m2, respectivement) exposant le sujet à un risque d’accident hyperthermique auquel s’ajoute une déshydratation (2 % du poids corporel) ce qui sollicite particulièrement le système cardio-vasculaire. Ceci conduit à préconiser des durées limites d’utilisation de la tenue TIVA pour un exercice physique type dans des conditions climatiques connues (entre 25 et 45 °C)