Emergency Public Health & Disaster Medicine
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  • 1. Emergency Public Health and Disaster Medicine Bobby Kapur, M.D., M.P.H. Associate Professor of Medicine & Pediatrics Associate Chief for Academic Affairs Section of Emergency Medicine
  • 2. Emergency Public Health 1 1. Present the scope & impact of Public Health Emergencies 2. Define the concept of Emergency Public Health 3. Differentiate Emergency Public Health from Disaster Medicine 4. Show how Emergency Public Health can lead to Public Health Security Objectives
  • 3. Emergency Public Health 2 Public Health Emergencies Scope of Problem
  • 4. Baylor College of Medicine 3 Natural Public Health Emergencies Sichuan Earthquake May 19, 2008
  • 5. Emergency Public Health 4 Industrial Public Health Emergencies BP Gulf of Mexico Explosion April 20, 2010
  • 6. Emergency Public Health 5 Infectious Disease Public Health Emergencies
  • 7. Emergency Public Health 6 Terrorism Public Health Emergencies 9/11/2001
  • 8. Emergency Public Health 7
  • 9. Emergency Public Health 8 Increasing Threats to Cities 0 10 20 30 40 50 60 70 801988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 Number of Declared US Disasters 1988-2008 (Source: Data from FEMA http://www.fema.gov/news/disaster_totals_annual.fema)
  • 10. Emergency Public Health 9 Increasing Densities of Cities 0 10 20 30 40 50 60 70 80 90 100 PercentGlobalPopulationUrban 1950 1965 1980 1995 2010 2025 2040 Year Current and Projected Percentage of Global Population Living in Urban Areas (Source: Data from UN. http://esa.un.org/unup/index.asp?panel=1)
  • 11. Emergency Public Health 10 Emergency Public Health New & Emerging Field
  • 12. Emergency Public Health 11 Emergency Public Health: A New Concept • New field of academic study • “Public Health” approach to large-scale emergencies and crises • Population-based analysis
  • 13. Emergency Public Health 12 Emergency Public Health vs. Disaster Medicine “Hazards”: events that cause Emergencies – Natural (earthquakes, hurricanes, droughts) – Deliberate (bombing, chemical attack, biological attack) – Accidental (nuclear plant malfunction) “Disaster”: event that overcomes local resources
  • 14. 13 Disasters: Causes?
  • 15. Emergency Public Health 14 Disaster Cycle Hazard
  • 16. Emergency Public Health 15 Emergency Public Health vs. Disaster Medicine Emergency Public Health differs from Disaster Medicine because it encompasses more than just the management of specific hazards.
  • 17. Emergency Public Health 16 Emergency Public Health and the Disaster Cycle Hazard Epidemiology Rapid Needs Assessment Surveillance & Monitoring
  • 18. Emergency Public Health 17 Emergency Public Health vs. Disaster Medicine Hazard Patients Govt: EMS Fire Police Hosps Private Sector NGOs Public Health Law Technology Epidemiology Rapid Needs Assessments Surveillance Monitoring Disaster Medicine Emergency Public Health Acad Centers
  • 19. Emergency Public Health 18 Multiple components of society will be disrupted by public health emergencies: – Physical and Mental Health – Security – Housing – Food and Water Long period of rehabilitation Emergency Public Health: Broad Impact
  • 20. Emergency Public Health 19 Large-scale crises will affect all sectors: – Government – Private sector – Non-governmental Organizations (NGOs), – Civilians Each sector will provide and utilize resources during a crisis Emergency Public Health: Multiple Sectors
  • 21. Emergency Public Health 20 Emergency Public Health Public Health Security
  • 22. Emergency Public Health 21
  • 23. Emergency Public Health 22 Public Health Security Framework
  • 24. Emergency Public Health 23 Resilience: a population’s capacity to withstand adversity and to recover quickly Cities will achieve greater levels of protection from collapse by increasing: – Systemized surveillance – Assessments – Coordination – Communication Emergency Public Health: Resilience
  • 25. Emergency Public Health 24 Resilience Analysis Model
  • 26. Emergency Public Health 25 Emergency Public Health Government & Public Health Emergencies
  • 27. Emergency Public Health 26 National Government Institute of Medicine (IOM) states there are 6 major roles of the government in public health: 1.Policy 2.Finance 3.Public health protection 4.Information gathering and dissemination 5.Capacity building 6.Direct patient health care services
  • 28. Emergency Public Health 27 National Response Framework
  • 29. Emergency Public Health 28 Key Components of Mutual Aid Agreements Interoperability of Communications Credentialing of Responders Financial Responsibilities Procedures for Requesting Resources and Personnel Command and Control of Personnel and Resources Liability (Source: Data from Department of Homeland Security. National Response Framework. Washington, DC 2008. Available at http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf.)
  • 30. Emergency Public Health 29 Public Health Law Type of Law Example in Public Health Emergency Brief Description Common Law Public/Private Nuisance Negligence Preventing a person from maintaining an unhealthy condition on his property and from unreasonably interfering with another person’s use and enjoyment of his property. Requiring a person to exercise the care that a reasonable person would exercise to prevent foreseeable harm. Statutory Law National Emergencies Act Homeland Security Act of 2002 Emergency Medical Treatment and Active Labor Act Preventing open-ended states of national emergency. Creating the US Department of Homeland Security which is charged with preventing terrorist attacks in the US and responding to natural disasters. Requiring participating hospitals to treat and stabilize patients with emergency conditions, regardless of ability to pay. Constitutional Law US Constitution, Art. I, Sect. 8 US Constitution, IV Amendment Defining the powers of Congress, including the power to collect taxes, to provide for the common defense and general welfare of the US, and to regulate commerce among the States. Prohibiting unreasonable searches and seizures of persons or property. Administrative Administrative Procedures Act Detailing the way in which administrative agencies may propose and establish
  • 31. Emergency Public Health 30
  • 32. Emergency Public Health 31 Emergency Public Health Non-Government Sector
  • 33. Baylor College of Medicine 32 Public-Private Partnerships (PPPs): Incentives 1. Growing sense of corporate social responsibility, which includes staff motivation 2. Benefits of “positive branding” 3. Business intelligence 4. Pure willingness to do good
  • 34. Emergency Public Health 33
  • 35. Emergency Public Health 34 Code of Conduct for NGOs in Public Health Emergencies First priority is the Humanitarian imperative (the right to receive humanitarian assistance, unimpeded access to affected populations). Aid is given regardless of race, creed or nationality and is prioritized based on need alone. Aid will not be used as a tool to support a particular political or religious standpoint. NGOs will act independent of governments and not act as instruments of government foreign policy. Culture, structures and customs of communities and countries will be respected. Emergency public health response will attempt to strengthen local capacities (staff, materials, companies, local NGOs), when possible. Intended beneficiaries should be involved in the design, management and implementation of assistance programs, when possible. Relief efforts should not only meet basic needs but should strive to reduce future vulnerabilities to public health emergencies (mitigation). NGOs will be accountable to their partners, both the populations who need assistance and the donors who wish to assist, in a responsible and transparent manner. NGOs will recognize victims as dignified people and not hopeless individuals in their organization’s information, publicity and advertising activities.
  • 36. Emergency Public Health 35 Emergency Public Health Public Health Tools
  • 37. Emergency Public Health 36 • Epidemiological Studies • Rapid Needs Assessments • Surveillance & Monitoring • Evaluation Processes Emergency Public Health: Public Health Tools
  • 38. Emergency Public Health 37 Epidemiology in Public Health Emergencies
  • 39. Emergency Public Health 38 Role of Epidemiological Studies in Public Health Emergencies Epidemiological Studies Data Collected Limitations Case series: sequence of case reports with common elements such as similar clinical features and suspected common exposures Clinical features Specialized treatment of specific types of injuries Lack of generalizations Non-reporting of less severe injuries treated outside the hospital setting Cross sectional: study of several individuals at one point in time about information on health status, health- related behaviors, and other exposure factors Frequencies of mortality and morbidity Behaviors during and after emergencies Diversity of outcomes experienced during the event Absence of population counts Poor sampling methods leading to non-representative samples Bias from selective survival, population movement, and recall Case control: study of individuals in whom a disease has already occurred in order to find out whether these individuals have been exposed to a particular risk factor Risk factors Bias due to selection of cases and controls Cohort study: study of a group exposed to a particular factor and another group not exposed to this factor is followed up over time to determine occurrence of disease Estimate incidence and magnitude of risk Short and long-term and direct and indirect health effects Emergency-related outcomes Identification of a defined cohort Logistics of long-term data collection Loss to follow up
  • 40. Emergency Public Health 39 Rapid Needs Assessments: Cluster Sampling
  • 41. Emergency Public Health 40 Feedback Mechanisms • Surveillance • Monitoring • Evaluation Professionalization of responding and managing public health emergencies.
  • 42. Emergency Public Health 41 WHO Framework for Surveillance
  • 43. Emergency Public Health 42 Conclusions 1. Public Health Emergencies are broad-scale events that impact many areas and have long periods of recovery and rehabilitation 2. Public Health Security depends on a region’s Resilience 3. Public Health Tools can help manage these emergencies and guide decision-making