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This chapter looks at the ways how, from 1948 onwards, the meaning of the trials changed in light of the broader Cold War context internationally and intensifying criticism domestically. Administratively, the trials were coming to an end. They had, from the perspective of the public authorities, succeeded in their original purposes of securing inner peace and stability during the early months following the liberation. Yet, from 1948 onwards, they became acutely relevant in light of the new political threats and challenges the Norwegian state faced, at the same time as the authorities sought to defend their legacy in light of mounting criticism from some sentenced collaborators and public intellectuals. This chapter therefore argues that the final stages of the trials assumed a renewed demonstrative dimension as the government sought to reassert its administrative and interpretative authority over the trials in a changed political context.
Anthrax is a bacterial zoonotic disease caused by Bacillus anthracis. We qualitatively examined facilitators and barriers to responding to a potential anthrax outbreak using the capability, opportunity, motivation behaviour model (COM-B model) in the high-risk rural district of Namisindwa, in Eastern Uganda. We chose the COM-B model because it provides a systematic approach for selecting evidence-based techniques and approaches for promoting the behavioural prompt response to anthrax outbreaks. Unpacking these facilitators and barriers enables the leaders and community members to understand existing resources and gaps so that they can leverage them for future anthrax outbreaks.
This was a qualitative cross-sectional study that was part of a bigger anthrax outbreak simulation study conducted in September 2023. We conducted 10 Key Informant interviews among key stakeholders. The interviews were audio recorded on Android-enabled phones and later transcribed verbatim. The transcripts were analyzed using a deductive thematic content approach through Nvivo 12.
The facilitators were; knowledge of respondents about anthrax disease and anthrax outbreak response, experience and presence of surveillance guidelines, availability of resources, and presence of communication channels. The identified barriers were; porous boarders that facilitate unregulated animal trade across, lack of essential personal protective equipment, and lack of funds for surveillance and response activities.
Generally, the district was partially ready for the next anthrax outbreak. The district was resourced in terms of human resources but lacked adequate funds for animal, environmental and human surveillance activities for anthrax and related response. The district technical staff had the knowledge required to respond to the anthrax outbreak but lacked adequate funds for animal, environmental and human surveillance for anthrax and related response. We think that our study findings are generalizable in similar settings and therefore call for the implementation of such periodic evaluations to help leverage the strong areas and improve other aspects. Anthrax is a growing threat in the region, and there should be proactive efforts in prevention, specifically, we recommend vaccination of livestock and further research for human vaccines.
The concurrent challenges of the COVID-19 pandemic and a significant earthquake in Izmir on October 30, 2020, presented a unique scenario for disaster management and response. This study focuses on the impact of the earthquake, which resulted in 117 fatalities, including 1 due to drowning, and injured 1034 individuals, alongside widespread structural damage including to the Izmir Democracy University Buca Seyfi Demirsoy Training and Research Hospital. The objective is to assess the activation and implementation of the hospital disaster plan amidst the ongoing pandemic. Through a retrospective evaluation of all actions undertaken as per the Hospital Disaster Emergency Plan within the Disaster Management cycle, this study examines the decision-making process for the hospital evacuation on October 30, 2020, the evacuation of COVID-19 patients, and the strategies employed to increase hospital capacity. Of 216 patients hospitalized at the time of the earthquake, 65 were transferred to other facilities under COVID-19 protocols. The prolonged nature of pandemics and the likelihood of secondary disasters underscore the importance of comprehensive risk assessments and dynamic disaster planning, considering simultaneous multiple hazards. This study suggests the inclusion of multi hazard scenarios and diverse evacuation methods by using types of ambulances, such as ground, helicopter, and boat.
Older adults often have a heightened awareness of death due to personal losses. In many low- and middle-income countries, including Nigeria, conversation about end-of-life issues and advanced care planning (ACP) among older adults is gradually emerging. Our study explored older adults’ knowledge and perceptions towards advanced directives and end-of-life issues in a geriatric care setting in Nigeria.
Methods
A cross-sectional study was conducted among older adults (aged ≥60 years) in a geriatric outpatient clinic. Data were collected using an interviewer-administered, semi-structured questionnaire, tested at a significance level set at alpha 0.05.
Results
The study included 204 participants with a mean age of 71.3 ± 7.2 years, predominantly female (67.2%). Few of the participants have heard about end of life (20.1%), living will (19.1%), power of attorney (19.6%), and ACP (25.9%). About 29.9% of the respondents considered having a living will, of which about 34.4% have written one. Only 23 (11.3%) would consider discussing ACP in the future, 32 (15.7%) would discuss place of care, and 30 (14.7%) place of death. Preparedness for end of life and knowledge of ACP was higher among males, those with formal education, and those with good self-rated health (p < 0.05).
Significance of results
The study highlighted gap in awareness and engagement in ACP among older adults in a country like Nigeria. This lack of knowledge can lead to inadequate end-of-life care and unpreparedness for critical health decisions for older adults in Africa. Thus, improving awareness and understanding of ACP can empower older adults, ensuring their end-of-life preferences are respected, enhancing the quality of care, and reducing the emotional and financial burden on families.
To describe COVID-19 pandemic preparedness and response in 6 countries during 2020 and 2021.
Methods
A literature search was conducted in MEDLINE, Web of Science, Epistemonikos, LILACS, and Google Scholar regarding the measures adopted to face the COVID-19 pandemic; the checklist of the international World Healths Organization’s (WHO) guide “COVID-19 Strategic Preparedness and Response Plan” was applied.
Results
Most countries coordinated their response at the central level with the establishment of management teams and the activation of emergency operations centers for the coordination of the response to the pandemic. The capacity to perform epidemiological surveillance activities such as early case detection, contact tracing, and real-time monitoring of data was exceeded. There was low capacity in laboratory infrastructure, specialized human talent, and deployment of molecular testing for SARS-CoV-2 detection.
Conclusions
This is the first review that addresses the importance of documenting how well-prepared countries in the region were to face a pandemic such as COVID-19 taking into account WHO standards and guidelines. In Latin America, the literature showed reports of heterogeneous responses to the pandemic, a gap in the literature on laboratory and diagnostic pillar activities, and a lack of literature reporting on epidemiological surveillance pillar activities in Argentina, Chile, and Ecuador.
Chemical, biological, radiological, and nuclear (CBRN) incidents require meticulous preparedness, particularly in the Middle East and North Africa (MENA) region. This study evaluated CBRN response operational flowcharts, tabletop training scenarios methods, and a health sector preparedness assessment tool specific to the MENA region.
Methods
An online Delphi survey engaging international disaster medicine experts was conducted. Content validity indices (CVIs) were used to validate the items. Consensus metrics, including interquartile ranges (IQRs) and Kendall’s W coefficient, were utilized to assess the panelists’ agreement levels. Advanced artificial intelligence computing methods, including sentiment analysis and machine-learning methods (t-distributed stochastic neighbor embedding [t-SNE] and k-means), were used to cluster the consensus data.
Results
Forty experts participated in this study. The item-level CVIs for the CBRN response flowcharts, preparedness assessment tool, and tabletop scenarios were 0.96, 0.85, and 0.84, respectively, indicating strong content validity. Consensus analysis demonstrated an IQR of 0 for most items and a strong Kendall’s W coefficient, indicating a high level of agreement among the panelists. The t-SNE and k-means identified four clusters with greater European response engagement.
Conclusions
This study validated essential CBRN preparedness and response tools using broad expert consensus, demonstrating their applicability across different geographic areas.
Emergency Medical Services (EMS) workers are critical to effective disaster response. Therefore, it is important to understand their knowledge, skills, and preparedness for disasters. This study investigated factors influencing EMS workers’ disaster knowledge, skills, and preparedness in the Saudi Arabian context. The study also sought to identify challenges to disaster preparedness among Saudi Arabian EMS workers.
Methods
A descriptive cross-sectional survey using The Disaster Preparedness Evaluation Tool was distributed to EMS workers in military and government hospitals across 3 Saudi Arabian cities. Responses were recorded on a 6-point Likert scale where higher scores indicated higher knowledge, skills, or preparedness. The results were analysed using descriptive and inferential statistical analysis.
Results
272EMS workers participated in this study. EMS workers reported a moderate level of knowledge (3.56), skills (3.44), and preparedness (3.73) for disasters. Despite this, EMS workers reported a high level of involvement in regular disaster drills (M = 4.24, SD = 1.274) and a strong interest in further disaster education opportunities (M = 5.43, SD = 1.121). Participants also reported a high skill level with the triage principles used in their workplace during a disaster (M = 4.06, SD = 1.218). The study findings revealed a significant positive correlation between disaster preparedness levels and age, years of experience, education level, and the facility worked in.
Conclusions
EMS workers have moderate disaster knowledge, skills, and preparedness levels. Knowledge, skill, and preparedness have a significant relationship on the EMS workers’ demographics. These findings demonstrate the need to invest in preparing Saudi Arabian EMS workers to effectively respond to bioterrorism disasters.
There are numerous challenges for pet owners in developing countries before, during, and after disasters, comprising poor communication between pet owners and veterinarians for periodic pet check-ups, lack of necessary equipment, lack of proper disaster evacuation training, and a proper shelter to be considered for pets during periods of disasters. In the present letter, a variety of measures and recommendations have been provided, which can be kept in mind throughout the entire disaster management cycle to prevent pet loss.
The United States Government (USG) public-private partnership “Accelerating COVID-19 Treatment Interventions and Vaccines” (ACTIV) was launched to identify safe, effective therapeutics to treat patients with Coronavirus Disease 2019 (COVID-19) and prevent hospitalization, progression of disease, and death. Eleven original master protocols were developed by ACTIV, and thirty-seven therapeutic agents entered evaluation for treatment benefit. Challenges encountered during trial implementation led to innovations enabling initiation and enrollment of over 26,000 participants in the trials. While only two ACTIV trials continue to enroll, the recommendations here reflect information from all the trials as of May 2023. We review clinical trial implementation challenges and corresponding lessons learned to inform future therapeutic clinical trials implemented in response to a public health emergency and the conduct of complex clinical trials during “peacetime,” as well.
As the world comes together through the WHO design and consultation process on a new medical counter-measures platform, we propose an enhanced APT-A (Access to Pandemic Tools Accelerator) that builds on the previous architecture but includes two new pillars – one for economic assistance and another to combat structural inequalities for future pandemic preparedness and response. As part of the APT-A, and in light of the Independent Panel on Pandemic Preparation & Response's call for an enhanced end-to-end platform for access to essential health technologies, we propose a new mechanism that we call the Pandemic Open Technology Access Accelerator (POTAX) that can be implemented through the medical countermeasures platform and the pandemic accord currently under negotiation through the World Health Assembly and supported by the High-Level Meeting review on Pandemic Prevention, Preparedness, and Response at the United Nations. This mechanism will provide (1) conditional financing for new vaccines and other essential health technologies requiring companies to vest licenses in POTAX and pool intellectual property and other data necessary to allow equitable access to the resulting technologies. It will also (2) support collective procurement as well as measures to ensure equitable distribution and uptake of these technologies.
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
Providing medical care during a mass event requires important situational awareness and preparation. Significant planning and relationship building provides a foundation for creating an operational outline, and establishing crowd dynamics and expectations for related medical activities. Collaboration with stakeholders will provide insight into the operations of various other event management entities, and allows for more seamless operations during the event. Once an operational plan has been established and circulated, the event medical team can be prepared for the expected external and crowd conditions and respond appropriately, while maintaining vigilance for any emergency that may arise. Contingency planning is key for the medical team to have appropriate emergency response defaults. Special attention is also needed on communications strategies for real-time intel, information dissemination, and crowd management. Once the event reaches its end, it is important to establish stand-down procedures to be followed as the crowd disperses to ensure an orderly event closure. After action reports can provide valuable insights for future crowd management.
This chapter deals with public health and pandemic preparedness. It recognises the five stages of a new pandemic (detection, assessment, treatment, escalation and recovery). The chapter also deals with the issue of laboratory preparedness and the need to maintain a critical mass of laboratory and skilled staff expertise at all times in order to be able to respond rapidly and effectively to a new emerging pandemic.
A cross-sectional, mixed-method study was conducted in Badin, a rural area in southern Sindh, which is considered a high-risk disaster zone, to assess the vulnerability, preparedness, and disaster experiences of the coastal population. A multistage sampling technique was employed to select the villages, study area, and 3 distinct populations (I, II, and III). Family heads of households were recruited for population I, village heads for population II, and community support group leaders from selected clusters for population III. The survey was conducted through face-to-face interviews. The results revealed that the population of rural southern Sindh, Pakistan, is highly vulnerable to disasters and exhibits lower levels of preparedness. The statistics about the vulnerable population may prove helpful in designing policies targeting specific groups to mitigate hazards in the future.
In contemporary healthcare, the crucial importance of disaster preparedness and response within the nursing profession has gained recognition. Considering the elevated probability of encountering numerous disasters in Türkiye, it is noteworthy that limited research has been conducted in this domain. This study, therefore, aims to investigate the related factors to nurses’ disaster preparedness Türkiye through a meta-analysis method.
Methods:
The study was conducted based on PRISMA guidelines. We searched the national databases in Türkiye and Web of Science Core Collection. Descriptive studies published in Turkish or English between 01.01.2000-31.12.2021 in Türkiye were included in the study to derive the pooled outputs.
Results:
A total of nine studies, encompassing a sample size of 3222 nurses, met the inclusion criteria. The meta-analysis’ results revealed that gender and prior experience with disasters did not exhibit a statistically significant impact on nurses’ disaster preparedness (p>0.05). Conversely, engaging in disaster education programs, familiarizing oneself with disaster plans, and actively participating in disaster drills were found to have a significant positive effect on nurses’ preparedness for disasters (p<0.05). However, it is worth noting that the analysis of disaster experience exhibited substantial heterogeneity (I2=85.6%), indicating variations among the included studies. Similarly, the analysis related to reading disaster plans also demonstrated high heterogeneity (I2=77.7%).
Conclusion:
Based on the available evidence from the meta-analysis, it can be concluded that receiving disaster education, reading disaster plans, and participating in disaster drills have a positive and significant impact on nurses’ perception of disaster preparedness.
Cross jurisdictional collaboration efforts and emergency vaccine plans that are consistent with Tribal sovereignty are essential to public health emergency preparedness. The widespread adoption of clearly written federal, state, and local vaccine plans that address fundamental assumptions in vaccine distribution to Tribal nations is imperative for future pandemic response.
The aim of this study was to compare past New Zealand immunization strategies with the New Zealand coronavirus disease 2019 (COVID-19) immunization roll-out.
Methods:
Using the READ document analysis method, 2 New Zealand immunization strategies (for influenza and measles) were analyzed for how the disease, context, vaccine supply and demand, ethical principles (equity, individual autonomy, and maximizing benefits), and the Treaty of Waitangi impacted the immunization programs. The findings were compared with the ongoing COVID-19 mass immunization program in New Zealand, as of October 15, 2021.
Results:
Several themes common to the case-studies and the COVID-19 pandemic were identified including the importance of equity, obligations under the Treaty of Waitangi, ethical mandates, and preparedness.
Conclusions:
Future emergency planning should integrate learnings from other infectious disease responses and immunization programs to avoid repeating mistakes and to create better health outcomes. This study has provided a basis for ongoing research into how an appropriate immunization plan can be developed that incorporates ethical values, the Treaty of Waitangi (in the NZ context), and evidence-based research to increase trust, equity, health, and preparedness for future outbreaks.
Interest in nuclear power as a cleaner and alternative energy source is increasing in many countries. Despite the relative safety of nuclear power, large-scale disasters such as the Fukushima Daiichi (Japan) and Chernobyl (Ukraine) meltdowns are a reminder that emergency preparedness and safety should be a priority. In an emergency situation, there is a need to balance the tension between a rapid response, preventing harm, protecting communities, and safeguarding workers and responders. The first line of defense for workers and responders is personal protective equipment (PPE), but the needs vary by situation and location. Better understanding this is vital to inform PPE needs for workers and responders during nuclear and radiological power plant accidents and emergencies.
Study Objective:
The aim of this study was to identify and describe the PPE used by different categories of workers and responders during nuclear and radiological power plant accidents and emergencies.
Methods:
A systematic literature review format following the PRISMA 2020 guidelines was utilized. Databases SCOPUS, PubMed, EMBASE, INSPEC, and Web of Science were used to retrieve articles that examined the PPE recommended or utilized by responders to nuclear radiological disasters at nuclear power plants (NPPs).
Results:
The search terms yielded 6,682 publications. After removal of duplicates, 5,587 sources continued through the systematic review process. This yielded 23 total articles for review, and five articles were added manually for a total of 28 articles reviewed in this study. Plant workers, decontamination or decommissioning workers, paramedics, Emergency Medical Services (EMS), emergency medical technicians, military, and support staff were the categories of responders identified for this type of disaster. Literature revealed that protective suits were the most common item of PPE required or recommended, followed by respirators and gloves (among others). However, adherence issues, human errors, and physiological factors frequently emerged as hinderances to the efficacy of these equipment in preventing contamination or efficiency of these responders.
Conclusion:
If worn correctly and consistently, PPE will reduce exposure to ionizing radiation during a nuclear and radiological accident or disaster. For the best results, standardization of equipment recommendations, clear guidelines, and adequate training in its use is paramount. As fields related to nuclear power and nuclear medicine expand, responder safety should be at the forefront of emergency preparedness and response planning.
This study aims to evaluate disaster preparedness of undergraduate nursing students.
Methods:
This descriptive cross-sectional study included 302 voluntary nursing students from a university in Northern Cyprus. Data were collected through an online survey using Google Forms, which included a descriptive information form and the General Disaster Preparedness Belief Scale (GDPBS).
Results:
The mean age of the participants was 20.64 ± 2.02 years. Among the participants, 41.7% had prior experience with disasters, and 77.2% expressed a need for disaster education. The average GDPBS total score was high, and the mean score of the sub-dimensions was moderate. Nursing students who expressed a need for disaster education had higher scores on the severity and self-efficacy subscales of the GDPBS (p<0.05).
Conclusion:
The level of disease preparedness was moderate in nursing students in Northern Cyprus. Therefore, education based on the health belief model, which assumes that positive health behaviors are affected by knowledge and attitudes, may be useful to improve disaster preparedness in nursing students.
The study aimed to determine the level of knowledge and perceptions of preparedness for disasters among nurses working in a tertiary university hospital.
Method:
The population of this cross-sectional study consisted of nurses working in a university hospital in the Eastern Black Sea Region of Turkey (n = 340). The sample included 183 nurses who were determined using the OpenEpi program and the universal sampling method. The data were collected using the Sociodemographic Information Form and the Disaster Preparedness Perception Scale in Nurses (DPPSN) and analyzed using SPSS 22 software.
Results:
The mean age of the participants was 34.31 + 8.52 years; 83.1% were female, 66.1% had at least a bachelor’s degree and worked in a surgical ward, 49.7% had been working for at least 11 years, and 58.5% had received training on disasters. Those who received disaster-related training received it mostly face to face (70.1%) from their institutions (91.6%) and in the form of 2–4 hours of training (75.7%); 52.5% had previously participated in a disaster-related drill, and 83.1% took on the role of caregiver during a disaster. The DPPSN mean score of the nurses involved in the study was found to be 3.53 ± 0.58 out of 5 points for the total scale.
Conclusion:
The results of the study showed that nurses considered themselves partially adequate for disaster preparedness, in general.
Many patients with advanced cancer identify home as being their preferred place of death. A critical component in achieving a home death is the support of family members, who often take on responsibilities for which they feel insufficiently prepared with subsequent impacts upon their health and well-being.
Objectives
This study sought to review existing qualitative literature on family carers’ experiences in providing end-of-life care at home for patients with advanced cancer, with an emphasis on exploring factors that influence how prepared they feel for their role.
Methods
A narrative review was chosen to provide an overview and analysis of qualitative findings. MEDLINE, PubMed, PsychINFO, and EMBASE databases were searched with the following search terms: “Cancer,” “Caregiver,” “End of Life Care,” “Home,” and “Qualitative.” Inclusion criteria were as follows: English language, empirical studies, adult carers, and articles published between 2011 and 2021. Data were abstracted, and study quality was assessed using the Critical Appraisal Skills Programme checklist for qualitative research.
Results
Fourteen relevant articles were included. Three overarching themes reflecting the factors influencing family preparedness for their role were identified: “motivations for providing care,” “interactions with health-care professionals,” and “changes during the caring process.”
Significance of results
Inadequate preparation of family carers is apparent with regard to their role in providing end-of-life care at home for patients with advanced cancer. There is a need for health-care workers to more effectively identify the information and support needs of families, and utilize evidence-based strategies that have emerged to address these needs.