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Abstract

This discussion of key emergency health topics is meant to provide a primer for the public health practitioner beginning the study of emergency preparedness and response. The discussion focuses on the key concepts of: general principles of disaster management; emergency operations planning; incident management systems; disaster communications' mass casualty management; hazardous material response.
... Although various aspects of the operational response and clinical management of SARS have been reported from hospitals in several countries, little has been reported about overall hospital emergency management during a SARS outbreak (8 -21). Furthermore, despite the growing popularity of the Hospital Emergency Incident Command System (HEICS) as an organizational tool for hospital emergency management in the United States and elsewhere, little has been reported about the application of HEICS to actual hospital emergencies of any type (22)(23)(24). Accordingly, we sought to characterize the implementation of HEICS at a tertiary level hospital during the SARS outbreak in Taiwan, ROC. ...
... We excluded persons occupying leadership positions in the baseline HEICS plan that were not activated during the outbreak. The baseline HEICS plan at NCKUH has three fewer positions than the standard 49-position version used in the United States (i.e., a medical staff director, ancillary services director, and cardiopulmonary unit leader are absent) (23,24). ...
... The implementation of HEICS at NCKUH during this SARS outbreak illustrates several features of HEICS that seem to have assisted the organization of hospital emergency response at NCKUH (23,24). First, HEICS provided a flexible organizational structure that facilitated the creation of new units and subunits and new functions of hospital emergency response as the evolving crisis demanded. ...
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We sought to describe the implementation of the Hospital Emergency Incident Command System (HEICS) at National Cheng Kung University Hospital (NCKUH) in Taiwan, ROC during the outbreak of severe acute respiratory syndrome (SARS) in early 2003. We administered a 14-question survey via structured interviews to individuals occupying activated HEICS leadership positions at NCKUH to identify the organization, structure, and function of the HEICS units and subunits they led and the job actions they performed from 25 March to 16 June 2003 Thirty-three of 38 persons (87%) occupying 39 of 44 (89%) activated HEICS leadership positions directly participated in the survey. The participants collectively reported: 1) the creation of four new HEICS unit leader positions and corresponding units during the outbreak, including the infection control officer (administrative section) and SARS assessment, isolation, and critical care unit leaders (operations section); 2) the creation of six new HEICS subunits, including functional areas for fever screening, SARS assessment, and resuscitation outside the hospital, and SARS patient care, SARS critical care, and employee isolation inside the hospital; and 3) the performance of new job actions related to infection control by all HEICS unit leaders. HEICS provides a flexible framework that seems to have assisted NCKUH in the organization of its emergency response to the SARS outbreak in Taiwan, ROC.
... 25,26 Therefore, the first step should be to set up a disaster committee and incident command system aimed at enhancing the preparedness level of hospitals and facilitating all emergency management operations. 27,28 Communication is another essential component in dire need of improvement. Communication breakdown is a major challenge during disasters and can seriously affect the capacity of the system to respond. ...
... Communication breakdown is a major challenge during disasters and can seriously affect the capacity of the system to respond. 27,29,30 Sana'a hospitals need to outline a communications plan, which should also include the availability of backup systems, and to enable a reliable exchange of information with internal and external partners during all disasters. These communications links are most vulnerable to fail when a collapse of governance occurs, which is more likely to happen in a major civil unrest. ...
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Hospitals are expected to serve the medical needs of casualties in the face of a disaster or other crisis, including man-made conflicts. The aim of this study was to evaluate the impact of the 2011 Yemeni revolution on hospital disaster preparedness in the capital city of Sana'a. The study was conducted in September 2011 and 2013. For evaluation purposes, the hospital emergency response checklist published by the World Health Organization (WHO) was used. Additional information was also obtained to determine what steps were being taken by hospital authorities to improve hospital preparedness. The study selected 11 hospitals. At the time of the first evaluation, 7 hospitals were rated "unacceptable" for level of preparedness and 4 were rated "insufficient," receiving a WHO checklist rating of 10 to 98. At the second evaluation, 5 hospitals were rated "unacceptable," 3 "insufficient," and 1 "effective," receiving a rating of 9 to 134. Unfortunately, this study shows that between 2011 and 2013, no significant progress was made in hospital disaster preparedness in Sana'a. In a disaster-prone country like Yemen, the current situation calls for drastic improvement. Health system authorities must take responsibility for issuing strategic plans as well as standards, guidelines, and procedures to improve hospital disaster preparedness. (Disaster Med Public Health Preparedness. 2015;0:1-7).
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The Hospital Emergency Incident Command System (HEICS), now in its third edition, has emerged as a popular incident command system model for hospital emergency response in the United States and other countries. Since the inception of the HEICS in 1991, several events have transformed the requirements of hospital emergency management, including the 1995 Tokyo Subway sarin attack, the 2001 US anthrax letter attacks, and the 2003 Severe Acute Respiratory Syndrome (SARS) outbreaks in eastern Asia and Toronto, Canada. Several modifications of the HEICS are suggested to match the needs of hospital emergency management today, including: (1) an Incident Consultant in the Administrative Section of the HEICS to provide expert advice directly to the Incident Commander in chemical, biological, radiological, nuclear (CBRN) emergencies as needed, as well as consultation on mental health needs; (2) new unit leaders in the Operations Section to coordinate the management of contaminated or infectious patients in CBRN emergencies; (3) new unit leaders in the Operations Section to coordinate mental health support for patients, guests, healthcare workers, volunteers, and dependents in terrorism-related emergencies or events that produce significant mental health needs; (4) a new Decedent/Expectant Unit Leader in the Operations Section to coordinate the management of both types of patients together; and (5) a new Information Technology Unit Leader in the Logistics Section to coordinate the management of information technology and systems. New uses of the HEICS in hospital emergency management also are recommended, including: (1) the adoption of the HEICS as the conceptual framework for organizing all phases of hospital emergency management, including mitigation, preparedness, response, and recovery; and (2) the application of the HEICS not only to healthcare facilities, but also to healthcare systems. Finally, three levels of healthcare worker competencies in the HEICS are suggested: (1) basic understanding of the HEICS for all hospital healthcare workers; (2) advanced understanding and proficiency in the HEICS for hospital healthcare workers likely to assume leadership roles in hospital emergency response; and (3) special proficiency in constituting the HEICS ad hoc from existing healthcare workers in resource-deficient settings. The HEICS should be viewed as a work in progress that will mature as additional challenges arise and as hospitals gain further experience with its use.
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