Brian Schwartz

Brian Schwartz
University of Toronto | U of T · Dalla Lana School of Public Health

About

123
Publications
35,492
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3,552
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Introduction

Publications

Publications (123)
Article
Full-text available
Background The COVID-19 pandemic generated a growing interest in and need for evidence-based tools to facilitate the implementation of emergency management strategies within public health practice. Quality improvement (QI) is a key framework and philosophy to guide organizational emergency response efforts; however, the nature and extent to which i...
Preprint
Full-text available
Background: The COVID-19 pandemic generated a growing interest in and need for evidence-based tools to facilitate the implementation of emergency management strategies within public health practice. Quality improvement (QI) has been identified as a key framework and philosophy to guide organizational emergency response efforts; however, the nature...
Article
Full-text available
Strong communication systems for knowledge exchange are required to prevent, respond to and mitigate the effects of emerging public health incidents (EPHIs). The objective of this paper is to examine how “tacit knowledge” – implicit knowledge used to guide everyday practice – is employed in professional relationships and communication processes bet...
Article
Full-text available
Background Disasters and emergencies from infectious diseases, extreme weather and anthropogenic events are increasingly common. While risks vary for different communities, disaster and emergency preparedness is recognized as essential for all nation-states. Evidence to inform measurement of preparedness is lacking. The objective of this study was...
Article
Full-text available
Over their careers paramedics experience critical incidents that can negatively affect their emotional health, resulting in post-traumatic stress disorder (PTSD) and/or depression. They are at greater risk for PTSD than the general population (10% vs. 1.3%-3.5%) and other rescuer groups, likely due to frequency of exposure, workplace pressure, and...
Article
Introduction Public health emergency management involves the timely translation of relevant evidence and effective coordination of diverse actors. In practice, this can be challenging in the absence of a common framework for action among diverse actors. Aim To apply an Integrated Knowledge Translation (iKT) approach throughout the development of a...
Article
Full-text available
Background and purpose Ambulance workers could benefit from a method for early identification of incidents likely to result in long-term emotional sequelae. There is evidence that persistence of some measures of anxiety beyond the first week after an incident is associated with sequlae. In this study we test the hypothesis that persistence of self-...
Article
Full-text available
Background Emergencies and disasters impact population health. Despite the importance of upstream readiness, a persistent challenge for public health practitioners is defining what it means to be prepared. There is a knowledge gap in that existing frameworks lack consideration for complexity relevant to health systems and the emergency context. The...
Article
Full-text available
Given the steady rise of overdose morbidity and mortality in North America, and increasing frequency of sudden clusters of non-fatal and fatal overdoses in other jurisdictions, regional preparedness plans to respond effectively to clusters of overdoses may reduce the impact of such events on the population. On the 27th of February 2017 in Kingston,...
Article
Full-text available
Background Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to:...
Article
Study/Objective This research aims to conceptualize the essential elements of public health emergency preparedness in Canada. Background While emergency preparedness is a core public health function in Canada, public health emergency preparedness activities operate largely in the background until an event of concern raises their profile, as was ob...
Article
Full-text available
Background Ice, or freezing rain storms have the potential to affect human health and disrupt normal functioning of a community. The purpose of this study was to assess acute health impacts of an ice storm that occurred in December 2013 in Toronto, Ontario, Canada. Methods Data on emergency department visits were obtained from the National Ambulat...
Article
Full-text available
Background: Conflicting recommendations exist related to which facial protection should be used by health care workers to prevent transmission of acute respiratory infections, including pandemic influenza. We performed a systematic review of both clinical and surrogate exposure data comparing N95 respirators and surgical masks for the prevention of...
Article
Full-text available
Mass gatherings are heterogeneous in terms of size, duration, type of event, crowd behavior, demographics of the participants and spectators, use of recreational substances, weather, and environment. The goals of health and medical services should be the provision of care for participants and spectators consistent with local standards of care, prot...
Article
Full-text available
We outline a conceptual framework developed to meet the needs of public health professionals in the province of Ontario for incident management system-related education and training. By using visual models, this framework applies a public health lens to emergency management, introducing concepts relevant to public health and thereby shifting the fo...
Article
Full-text available
Background: Effective public health emergency preparedness and response systems are important in mitigating the impact of all-hazards emergencies on population health. The evidence base for public health emergency preparedness (PHEP) is weak, however, and previous reviews have noted a substantial proportion of anecdotal event reports. To investigat...
Article
The disciplines of paramedicine and emergency medicine have evolved synchronously over the past four decades, linked by emergency physicians with expertise in prehospital care. Ambulance offload delay (OD) is an inevitable consequence of emergency department overcrowding (EDOC) and compromises the care of the patient on the ambulance stretcher in t...
Technical Report
Full-text available
http://www.canadiancriticalcare.org/_assets/Ebola%20Clinical%20Care%20Guidelines_ENG.pdf
Technical Report
Full-text available
http://www.canadiancriticalcare.org/_assets/Ebola%20Clinical%20Care%20Guidelines_FR.pdf
Article
Full-text available
Effective workplace-based interventions after critical incidents (CIs) are needed for emergency medical technicians (EMT)/paramedics. The evidence for a period out of service post-CI (downtime) is sparse; however it may prevent posttraumatic stress disorder (PTSD) and burnout symptoms. We examined the hypothesis that downtime post-CI is associated...
Article
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To create a framework and methodology for organizing relevant disaster epidemiology literature. The target audience for the framework is local public health practitioners conducting emergency surveillance in the setting of preparedness or response to natural disasters. The approach to developing the framework involved utilizing the public health an...
Article
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To define and delineate the nontechnical core competencies required for disaster response, Disaster Medical Assistance Team (DMAT) members were interviewed regarding their perspectives and experiences in disaster management. Also explored was the relationship between nontechnical competencies and interprofessional collaboration. In-depth interviews...
Article
When responding to a novel infectious disease outbreak, policies are set under time constraints and uncertainty which can limit the ability to control the outbreak and result in unintended consequences including lack of public confidence. The H1N1 pandemic highlighted challenges in public health decision-making during a public health emergency. Und...
Article
In patients with ST-elevation myocardial infarction treated with fibrinolysis, routine early percutaneous coronary intervention (r-PCI) improves clinical outcomes at 30 days compared with a more standard approach of performing early PCI only for failed fibrinolysis (s-PCI). We report prespecified secondary clinical outcomes and cost implications of...
Article
Full-text available
Objectives: Weekly influenza-like illness (ILI) consultation rates are an integral part of influenza surveillance. However, in most health care settings, only a small proportion of true influenza cases are clinically diagnosed as influenza or ILI. The primary objective of this study was to estimate the number and rate of visits to the emergency de...
Article
Full-text available
During an influenza outbreak or pandemic, timely access to antivirals is essential to reduce disease severity and transmission. Best practices in antiviral procurement, storage, distribution, prescription and dispensing must be followed for prompt drug delivery. Mexico implemented a national pandemic preparedness plan in 2006 and created a strategi...
Article
Full-text available
Background Emergency medical technicians (EMTs) and paramedics experience critical incidents which evoke distress and impaired functioning but it is unknown which aspects of incidents contribute to their impact. We sought to determine these specific characteristics by developing an inventory of critical incident characteristics and testing their re...
Article
Full-text available
With increasing demands for emergency medical services (EMS), many EMS jurisdictions are utilizing EMS provider-initiated nontransport policies as a method to offload potentially nonemergent patients from the EMS system. EMS provider determination of medical necessity, resulting in nontransport of patients, has the potential to avert unnecessary em...
Article
Full-text available
To effectively prepare for a pandemic disease outbreak, knowledge of how the disease will spread is paramount. The global outbreak of severe acute respiratory syndrome (SARS) in 2002-2003 highlighted the need for such data. This need is also apparent in preparing for and responding to all disease outbreaks, from pandemic influenza to avian flu. Man...
Article
Full-text available
Ambulance workers are exposed to critical incidents that may evoke intense distress and can result in long-term impairment. Individuals who can regulate distress may experience briefer post-incident distress and fewer long-term emotional difficulties. Attachment research has contributed to our understanding of individual differences in stress regul...
Data
Full-text available
PREDICT Hospital Variables - Structured data set with variables abstracted from hospital charts.
Data
Full-text available
PREDICT Prehospital Variables - Structured data set with variables abstracted from Ambulance Call Reports (ACRs).
Article
Full-text available
Mental and physical symptoms are common in paramedics, which may relate to high work stress, including critical incidents. As previous trauma is a risk factor for psychological symptoms after exposure to critical incidents, the prevalence of childhood experiences with abuse and neglect and paramedics' adaptation to critical incidents may be importa...
Article
Full-text available
A standard of prehospital care for patients presenting with ST-segment elevation myocardial infarction (STEMI) includes prehospital 12-lead and advance Emergency Department notification or prehospital bypass to percutaneous coronary intervention centres. Implementation of either care strategies is variable across communities and neither may exist i...
Article
Full-text available
In Ontario, Canada, a mass vaccination strategy was developed and implemented to mitigate the effects of the 2009 pandemic influenza A (pH1N1). This study investigated its cost-effectiveness, mirroring actual events in Ontario, compared to no vaccine strategy. From a societal perspective, 1,780,491 cases and 154 deaths were averted through vaccine...
Article
A simulation experiment was used to test influenza pandemic mitigation strategies and to assess the number of simulation runs needed to make statistically and practically significant inferences. The scenarios tested include 11 levels of voluntary self-quarantine amongst infected individuals and two levels of public vaccination. Both self-quarantine...
Article
Full-text available
Ambulance workers could benefit from a method for early identification of incidents likely to result in long-term emotional sequelae. There is evidence that persistence of some measures of anxiety beyond the first week after an incident is associated with sequelae. In this study we test the hypothesis that persistence of self-identifiable component...
Conference Paper
Full-text available
There are several models used to predict the spread of disease in a pandemic, but few, if any, incorporate the effect of healthcare systems in preventing propagation of the disease. In areas where healthcare is easily available to the general public (specifically, countries with universal healthcare), the ability of infected individuals to receive...
Article
Concern over the adverse effects of heat on human health has led to numerous studies assessing the relationship between heat and mortality. Few studies have quantified the impact of heat on morbidity, including ambulance response calls. This study describes the association between temperature and ambulance response calls for heat-related illness (H...
Article
The aim of the study was to evaluate the feasibility of a prehospital trial comparing hypertonic saline and dextran (HSD) with normal saline (NS) in blunt head injury patients. The study used a double blind randomized trial. The study was conducted in air and land emergency medical services and 2 trauma centers serving a population of 4 million peo...
Conference Paper
Full-text available
Mathematical models to predict the spread of disease during a pandemic largely require overly simplistic assumptions about disease transmission within populations. One significant shortcoming of these models is the inability to account for varying types and amount of contact between individuals, to address individuals' behaviors or to assess the ef...
Article
Full-text available
Many emergency medical services (EMS) systems dispatch nonparamedic firefighter first responders (FFRs) to selected EMS 9-1-1 calls, intending to deliver time-sensitive interventions such as defibrillation, cardiopulmonary resuscitation (CPR), and bag-mask ventilation prior to arrival of paramedics. Deciding when to send FFRs is complicated because...
Article
There will be little time to prepare when an influenza pandemic strikes; hospitals need to develop and test pandemic influenza plans beforehand. Acute care hospitals in Ontario were surveyed regarding their pandemic influenza preparedness plans. The response rate was 78.5%, and 95 of 121 hospitals participated. Three quarters (76.8%, 73 of 95) of h...