Disaster Health Information Sources for Canadians


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Workshop given at the Canadian Health Sciences Library Association conference in Hamilton, Ontario on Tuesday June 12, 2012.

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  • Robin and Tara – Introduce ourselvesIntroduce the Wiki that provides links to all of the resources that will be used in the class. [Note: point out that the space between “Disaster” and “Information” is an underscore character]Mention that the slides will be available on slideshare. [Note: go straight into the exercise to introduce the participants]
  • TaraIce-breaker exercise. Ask people to identify the hazards on their own, then ask them to introduce themselves and to share the hazards from their provinces.
  • TaraThe following graph is an overview of the number of publications and the relative research interest in disaster topics. It was created using GoPubMed running a simple search using the Medical Subject Heading: DisastersWhat events do you think caused these three spikes in Relative Research Interest? 2001: 9/112005: Hurricane Katrina 2009: Haiti
  • TaraDemonstration of increase in publication output about disaster outbreaks.Take into account the increase in scholarly articles as a result of electronic publishing, there is still a marked increase following disasters that received high media coverage. H1N1 represents the biggest increase we’ve seen yet.Data from WHO Disease outbreaks by year: http://www.who.int/csr/don/archive/year/en/[Note: The following three slides are intended as a “Bridge” into the course – they will introduce the topic and pique the audience’s interest ; minimal time will be spent covering the information on these slides – quick overview only]
  • Tara[Point of this slide is to put the class in time context]Graph description: number of confirmed and probable cases of swine-origin influenza A (H1N1) virus (S-OIV) infection, by date of illness onset, in Mexico, during March 15 to April 26, 2009.
  • TaraFollowing a disaster, an explosion of available online information occurs. One of the challenges of searching for disaster information is having to navigate an influx of information and select best quality evidence to meet the information needs of the disaster workforce during the “Response” phase of a disaster. But disaster information needs don’t only occur during the response, but also during the mitigation, planning and recovery phases. In this course, we’ll describe information sources to meet the needs of all of these phases.
  • Robin[Note: The text below was shared with Cindy Olney to aid in preparing the baseline survey for the course evaluation; it covers all of the course objectives in more detail than the slide above; not necessary to mention all of these information types and resources at this point in the presentation – just pick out a few examples of each]By the end of the introductory course, participants will feel confident locating the following types of information:(1.) Peer-reviewed Articles & Books on Disaster Topics(2.) Standards and Reports on Health Facilities Disaster Management (3.) News Summaries and Information Portal Pages on Specific Disasters (i.e., Floods)(4.) Infectious Disease Surveillance Data(5.) Chemical Emergencies Information and Identification Tools(6.) Radiation Event Information and Exposure Estimators(7.) Information to Assist First RespondersBy the end of the introductory course, participants will feel confident using the following resources to locate disaster health information:(1.) PubMed(2.) NCBI Bookshelf(3.) HazLit(4.) DIMRC's Resource Guide for Public Health Preparedness(5.) PHE.gov Website(6.) FEMA Website(7.) DIMRC Website(8.) MedlinePlus(9.) CDC's (Centers for Disease Control and Prevention) MMWR (Mortality and Morbidity Weekly Report)(10.) ECDC's (European Centers for Disease Control and Prevention) Surveillance Data(11.) WHO's (World Health Organization) GAR (Global Alert and Response)(12.) WISER (13.) REMM(14.) CHEMMBy the end of the introductory course, participants will be knowledgeable about the following initiatives and tools for accessing disaster health inforamtion: (1.) NLM Emergency Access Initiative(2.) NN/LM Emergency Preparedness & Response Toolkit (3.) CDC Widgets, DIRLINE Widget for Disaster Organizations(4.) Email lists - ProMED-Mail, disastr-outreach listserv(5.) Apps – WISER, REMM, Relief Central & Reunite(6.) RSS feeds - CDC & WHO(7.) Twitter presence of US Government Agencies (FEMA, CDC, etc.) and other International Organizations (Red Cross, WHO, etc.)
  • Robin1 break scheduled for the 3.5 hour class – 15 minutes/30 minutes?
  • Tara Discussion: Can anyone define a health disaster? Key point: The impact of the event has or will exceed the resources of the local area to handle.Normally infectious diseases are not disasters; but, in the case of H1N1, a public health emergency was declared.
  • Tara Mention escalating incidents. An event can become a emergency; an emergency can become a disaster; etc.
  • Robin: Emphasize the breadth of topics captured under the subject “Disaster Medicine.”Highlight those topics which will be covered in the exercises:(1.) Emerging infectious diseases(2.) Mental & Behavioral Health(3.) Surveillance(4.) Hospital facility disaster management(5.) Surge Capacity: “rapid expansion of the capacity of the existing healthcare system in response to an event that results in increased need of personnel […], support functions (laboratories and radiological), physical space (beds, alternate care facilities) and logistical support (clinical and nonclinical equipment and supplies). (U.S. Dept of Homeland Security, 2007(6.) Chemical events(7.) Nuclear & Radiological Events(8.) Hazmat, toxic & industrial events(9.) FloodsAlso define: “All Hazards Preparedness” - Emergency preparedness requires attention not just to specific types of hazards but also to steps that increase preparedness for any type of hazard. (CDC, 2011)
  • TaraDisaster Workforce as “target audience” for disaster health information.   TL Note (Feb.8, 2012): the Emergency Support Functions for Canada’s Federal Emergency Response Plan can be found here:http://www.publicsafety.gc.ca/prg/em/ferp-eng.aspx#a52Emergency Health includes: public health, medical care, environmental health, medical equipment, pharmaceuticals and health care personnel.Emergency Social Services includes: clothing, lodging, food, registration and inquiry, personal services, reception centre management and social services personnel.Public Health Agency of Canada (PHAC) and Health Canada (HC) are the Ministries with primary responsibility for Emergency Support Functions, and this your best bets as sources of Canadian information during a disaster.Who comprises disaster workforce in Canada?Health professionals : usually practicing volunteer physicians, nurses, paramedics and other medical professionals (behavioural health professionals, radiologists). Can also include volunteer dentists, veterinarians (have basic medical training).But that’s just part of the workforce… community volunteers, firefighters, clergy, disaster mortuary team members…The point being that, in an disaster situation, your audience will have differing levels of experience/comfort with the kind of information you will be asked to provide (ex: for certain audiences, “patient education material” might be sufficient and more appropriate).
  • RobinCLICK to display questions.Ask class, in pairs, to discuss the case ; then have individuals present to the groupSome issues related to this case:(1.) Unavailability of indexed, peer-reviewed literature during the early phases of an outbreak of unknown infectious disease(2.) Information urgently needed to support administrative decision making ; sometimes the “best” quality evidence is really “the best that’s available”(3.) Need to start monitoring information sources in order to provide updates to administrators(4.) Potential information sources: CDC (http://www.cdc.gov/flu/professionals/antivirals/index.htm), ECDC, ISID, WHO (5.) What was a difficult question in April, 2009, is now a simple question to answer; Note - Now there is even a CDC widget on H1N1 and antivirals: 5 Clinician Quick Facts for 2009 H1N1 Flu Antivirals
  • RobinImage this triangle represents the body of disaster health information. It can be split into two parts:CLICK 1: Peer-reviewed scholarly literatureCLICK 2: “Grey” LiteratureNote: the amount of grey literature is much larger than the peer-reviewed, scholarly sources. But this is gradually changing as there is more research interest (as we saw at the beginning of the presentation) in disaster medicine. Today we’re going to be searching for both kinds of disaster information, using:CLICK 3: Sources for finding peer-reviewed journal articles and booksCLICK 4: Sources for finding reports, surveillance data, and other sources of disaster information [TL note: I added in PHAC logo]We’re going to complete some hands-on exercises using the following tools to search both peer-reviewed and grey literature sources.
  • RobinThe following are some PubMed-indexed journals that publish articles on topics related to Disaster Medicine.Note: this is only a list of the disaster medicine focused journals indexed in PubMed. There are Emergency Medicine journals with significant content on disaster health as well. And peer-reviewed disaster literature appears across many disciplines, in many journals.
  • RobinThere are many ways to describe information on disaster medicine/disaster health topics. CLICK to show: link for MeSH terms used in indexing disaster-related journal articles. Open URL. Note: There are many terms, besides just “disasters.” Consider checking this list to find terms to match your queries.
  • RobinNot all journal literature is publicly available at no cost. Many publishers require an individual or institutional subscription to access content. An opportunity to access disaster literature during the recovery period following a disaster event is NLM’s Emergency Access Initiative.Handbooks and guidebooks – very important references during the response phase (ex. Drug handbooks – many physicians practicing outside of their specialty areas). See NN/LM Toolkit for a “one shelf” reference library.
  • TaraGive the class about 10 – 15 minutes to complete the exercise(1.) PubMed – The National Library of Medicine’s database of published biomedical literature. Full text articles may only be available to subscribers. Search PubMedCentral to find all full-text articles.(2.) NCBI Bookshelf - A collection of freely available, downloadable, on-line versions of selected biomedical books.(3.) The NCTSN (National Child Traumatic Stress Network) is funded by the US Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services and jointly coordinated by UCLA Neuropsychiatric Institute and the Duke University Medical Center. The NCTSN increases access to services and raise the standard of care for traumatized children and their families.Questions to ask after this exercise: What are some problems encountered when searching these three sources? Was anyone able to find information to satisfy this request? Possible searchterms:Key words: child, psychology, hurricaneMeSHterms: Child; CyclonicStorms; Disasters; Stress Disorders, Post-TraumaticSome Target References: 1: McLaughlin KA, Fairbank JA, Gruber MJ, Jones RT, Osofsky JD, Pfefferbaum B, Sampson NA, Kessler RC. Trends in serious emotional disturbance among youths exposed to Hurricane Katrina. J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):990-1000, 1000.e1-2. Epub 2010 Sep 6. PubMed PMID: 20855044. 2: Kelley ML, Self-Brown S, Le B, Bosson JV, Hernandez BC, Gordon AT. Predicting posttraumatic stress symptoms in children following Hurricane Katrina: a prospective analysis of the effect of parental distress and parenting practices. J Trauma Stress. 2010 Oct;23(5):582-90. PubMed PMID: 20925099. 3: La Greca AM, Silverman WK, Lai B, Jaccard J. Hurricane-related exposure experiences and stressors, other life events, and social support: concurrent and prospective impact on children's persistent posttraumatic stress symptoms. J Consult Clin Psychol. 2010 Dec;78(6):794-805. PubMed PMID: 20939624. 4: Kronenberg ME, Hansel TC, Brennan AM, Osofsky HJ, Osofsky JD, Lawrason B. Children of Katrina: lessons learned about postdisaster symptoms and recovery patterns. Child Dev. 2010 Jul-Aug;81(4):1241-59. PubMed PMID: 20636693.
  • RobinSome questions require searching a combination of peer-reviewed and Grey Literature sources. Mention that some documents may not include earthquakes in their metadata, but contain good all-hazards preparedness information.(1.) DIMRC (Disaster Information Management Research Center) – Resource Guide for Public Health: gateway to grey literature resources that are freely available on the web.[Note: does not contain documents specifically on earthquakes, but does include many articles on hospital all-hazards preparedness.Possible search strategy: KW: Hospital preparedness](2.) Cochrane Evidence AidThe Cochrane Collaboration’s Evidence Aid project was established by The Cochrane Collaboration following the tsunami in the Indian Ocean in December 2004. It uses knowledge from Cochrane Reviews and other systematic reviews to provide reliable, up-to-date evidence on interventions that might be considered in the context of natural disasters and other major healthcare emergencies. Evidence Aid seeks to highlight which interventions work, which don’t work, which need more research, and which, no matter how well meaning, might be harmful; and to provide this information to agencies and people planning for, or responding to, disasters.Resources for earthquakes. Note: valuable reviews of topics that could be relevant in a disaster, but not specific to a disaster scenario/setting(3.) PAHO (Pan American Health Organization) – Area on Emergency Preparedness and Disaster Relief - PAHO generates and disseminates knowledge about all aspects of disaster preparedness, risk reduction and management by:Producing and distributing technical guidelines and publications on public health and disastersMaking up-to-date information available for decision making through the Emergency Operations Center and multiple web pagesIdentifying, collecting and disseminating lessons learned and evidence-based informationDeveloping information tools, services and centers, such as the Regional Disaster Information Center—CRIDCreating information networks and promoting the use of new ways to communicate, learn and share information among key actors. Possible search strategy: Select “Hospitals Safe From Disasters” > “Click on this link” under “Publications” > Select “Safe Hospitals Reference Documents (English)”(4.) PubMed – The National Library of Medicine’s database of published biomedical literature. Full text articles may only be available to subscribers. Search PubMedCentral to find all full-text articles.[Possible search strategy 1: ("earthquakes"[MeSH Major Topic]) AND "hospitals"[MeSH Major Topic]Possible search strategy 2: ("hospitals"[MeSH Terms]) AND "disaster planning"[MeSH Terms]Questions to ask after the exercise: What information wereyou able to find? Who in the disasterworkforcewouldneedthis information?
  • Tara(1.) ASPR’s Public Health Emergency website (phe.gov): Contains content mostly drawn from the CDC. It is more of an aggregator site (like DIMRC), but is intended to be a first stop for news about large-scale disasters. (2.) CDC’s Emergency Preparedness and Response: Many summary pages include information for both the general public and for professionals. The section on “Mass Casualties,” for example, has information on medical response to large-scale events. Pages on “surge capacity” and “blast injuries,” include fact sheets and treatment protocols. (3.) PHAC Emergency Preparedness and Response : most of the information is intended for a consumer audience, but it can be an excellent source for professionals as well (ex: Pathogen Safety Data Sheets, Surveillance).(4.)Canadian Disaster Database: Good source for retrospective information on Canadian disasters.  Lessons learned.
  • TaraHere are additional association websites that contain disaster health information for professionals. (1.) The American Academy of Pediatrics is the most comprehensive source for information about children’s health and disasters. (2.) The American College of Emergency Physicians has a page on Emergency Medical Services and Disaster Preparedness. The content changes based on current events, but it has information about how emergency physicians can volunteer and fact sheets that present relevant medical information in a quick format. One document linked here that is worth a look is “Unsolicited Medical Personnel Volunteering at Disaster Scenes,” which is a policy paper that basically directs medical professionals to only respond when asked by local incident management.(3.) The Canadian Red Cross is certainly a familiar organization, but worth a reminder here because of their leading role in responding to emergencies here in Canada.(4.) The World Association for Disaster and Emergency Medicine (WADEM) is an interdisciplinary NGO that includes doctors, nurses, emergency planners, dentists, first responders, and many other members of the disaster workforce. WADEM publishes the journal Prehospital and Disaster Medicine and a textbook called International Disaster Nursing. On their site, you can read another book online, called Health Disaster Management: Guidelines for Evaluation and Research, which aims to offer a common framework to do research in this area.
  • RobinIn Addition to the Natural Hazards Center, at the University of Colorado at Boulder, which produces HazLit, there are other academic centers that are potential sources of disaster health information for a professional audience. (1.) In contrast to the Natural Hazards Center which narrows its focus on non-manmade events, the Center for Biosecurity looks at biological weapons attacks and large-scale epidemics. Their site presents a lot of articles on threat assessment and mitigation, but one area that may be especially handy is under BioAgents, where there are fact sheets on agents that have been identified as particular threats. The fact sheets have background information and citations for you to go into deeper information about them. (2.) The Center for Infectious Disease Research and Policy is based at the University of Minnesota and focuses on response to emerging infectious diseases and preparedness, especially pandemic flu. One interesting aspect of their work is that they look at business preparedness, in short, how to keep the nation operating if there is a pandemic flu. For example, they have news articles about efforts to require employers to offer sick leave so that workers do not report for duty while they have the flu(3.) The Center for the Study of Traumatic Stress is part of the Uniformed Services University. On their website, look under Resources for a collection of PDF fact sheets having to do with the psychological consequences of situations, including disasters. Some of the resources are available in Creole and Chinese. This would be a very good resource for answering the question about children’s psychology following a hurricane.(4.) Disaster Research Center at the University of Delaware is another excellent source for research conducted on the psycho-social impact of disasters on different populations and one of the oldest academic centers on disaster research. The institutional repository at the University of Delaware hosts all of the research reports of the Center where electronic copies are available for free downloading.(5.) The Canadian Emergency Management College’s Reference Index (http://www.publicsafety.gc.ca/prg/em/cemc/07res-eng.aspx) can be an excellent source for case studies and lessons learned. Think of it as a great big Canadian disaster bibliography.Add college emergency management (PHAC) if public info resources availableAdd Justice Institute of BC siteTL: Many universities offer courses in disaster management Brandon University (Manitoba) – Applied Disaster and Emergency StudiesCentennial College (Ontario) – Emergency Management ProgramFleming College (Ontario) – Emergency ManagementGeorge Brown College (Ontario) – School of Emergency ManagementJustice Institute of British Columbia (BC) – Emergency Management DivisionNorthern Alberta Institute of Technology (Alberta) – Emergency Management DiplomaRoyal Roads University (BC) – Conflict and Disaster ManagementSheridan College Institute (Ontario) – Emergency ManagementYork University (Ontario) – Disaster & Emergency Management
  • TaraThe CDC website contains information on specific disaster events for a consumer audience. The slant of their information is towards health effects and containing infectious agents. Floods page: http://emergency.cdc.gov/disasters/floods/GetPrepared.gc.ca (mention provincial resources)MedlinePlus is specifically designed for a consumer audience. It contains some overview information and also links to other sites: http://www.nlm.nih.gov/medlineplus/floods.htmlQuestions to ask after the exercise: What information wereyou able to find? Who in the disasterworkforcewouldneedthis information?TL : Get prepared (http://www.getprepared.gc.ca/) has good info on what to DO (before, during, after), but not a great deal on health hazards associated with floods (brief section on Moulds in After section).
  • TaraQuestions to ask after the exercise: What information wereyou able to find? TL Note: Public Health Agency of Canada’s Flu Watch (Under Infectious Diseases) has weekly updates (and is only a week or two behind).Who in the disasterworkforcewouldneedthis information?
  • No attribution necessary for the photo (http://commons.wikimedia.org/wiki/File:A_small_cup_of_coffee.JPG)
  • Robin
  • RobinHazMat/CBRN Information-~420 Chemical Agents-~20 Radiological Agents-CDC Category A Biological AgentsIncludes-Substance characteristics/properties-Department of Transportation (DOT) Emergency Response Guidebook (ERG) data: Fire-fighting procedures, safe protective distance, etc.-Human health/medical treatment dataFeatures/Capabilities-Chemical identification support – via chemical properties, signs/symptoms, transportation, etc.-Safe protective distance mapping - GIS-Chemical reactivity featureWISER can be downloaded as a stand-alone application to Palm Pilots, Pocket PCs & Smartphones, PCs, iPhones, and AndroidsWISER can be viewed on any device with an internet browser.
  • TaraSubstance List > X > Xylenes > Protective Equipment & Clothing Substance List > X > Xylenes > Protective DistanceTL: Canadian Centre for Occupational Health and Safety would have also been a good Canadian Source.Complete Chemical Profile, PPE, First Aid info, etc. (definitely not as complete though).
  • RobinNotes - What you will find in REMM:Radiation principles (e.g., exposure vs contamination)Patient management algorithmsInitial onsite activitiesDecontamination proceduresAssess internal contaminationCountermeasuresAnother potentially good Canadian source for nuclear-related information would be the Canadian Nuclear Safety Commission -- http://nuclearsafety.gc.caThe Canadian Nuclear Safety Commission is a great source for first responders if they want to know about personal protective equipment, identification of nuclear substances, methods of detection, etc. Their radiation safety data sheets contain excellent information.
  • TaraQuestions to ask the class after the exercise: Could you find instructions for performing a survey for radiation contamination? Could you find treatment recommendations given the patient symptoms?
  • TaraQuestions to ask after the exercise: Where you able to identify the syndrome? What was it? And the recommended treatment? Did you find CHEMM intuitive to use? NOTE: Use CHEMM Intelligent Syndrome tool to find that the patient is most likely to be experiencing Pesticide Syndrome. Link to the information page on Nerve Agents - Emergency Department/Hospital Management
  • Robin“These tools can also be used to improve preparedness by linking the public with day-to-day, real-time information about how their community’s health care system is functioning. For example, emergency room and clinic waiting times are already available in some areas of the country through mobile-phone applications, billboard Really Simple Syndication (RSS) feeds, or hospital tweets. Routine collection and rapid dissemination of these measures of strain on a health care system can inform decision making by patients and health care providers and administrators. Monitoring this important information through the same social channels during an actual disaster may help responders verify whether certain facilities are over-loaded and determine which ones can offer needed medical care.” (Merchant, 2011)Note: Next Generation 9-1-1 (US) to accept texts, photos and videos. At the time of a disaster, disaster information sources (i.e., news) change – difference in where you should go for preparedeness and response information. Example: Going to news source vs. finding scholarly literature using social media
  • RobinBefore animation – Ask class what tools they use to stay current with news or medical information or any other topic of personal interest? Does any one currently use any of the tools mentioned to monitor disaster information?
  • RobinRelief Central. Includes: CIA World Factbook, USAID’s Field Operations Guide, CDC’s Yellow Book (Health Information for International Travel) , Summaries from MEDLINE Journals on Disaster Medicine, and News from the CDC, Red Cross, FEMA and ReliefWebNote: would be ideal for a disaster relief worker traveling to a foreign country and needing to acclimatize quickly to an unfamiliar environment.Also mention apps for WISER and REMMTL : Get Prepared also has a version of it’s site that has been optimized for Mobile devices.
  • RobinISID (International Society for Infectious Diseases) ProMED-mail (Program for MonitoringEmerging Diseases)Note: Mention that ProMED-Mail is also a surveillance tool.
  • TaraRSS: Really Simple SyndicationSubscribe to “feeds” from websites (look for the orange RSS icon)Use a feed reader (or aggregator) to read and organize your subscriptions. Many disaster health information sources produce RSS feeds. Subscribe to their feeds to monitor all web activity from a single site. So rather than visiting every site to see if there are any updates, just go to your feed reader.
  • TaraHere is a sample of some RSS feeds producing disaster health information, news, and surveillance data. For a list including links to these feeds, please see the MLA Moodle site for the course (TL - ???)
  • Twitter is a microblogging service, which means that people can use it to post very short messages. Some people might think of Twitter as a source for trivial news, but it tends to have very up to date information because it doesn’t take long to compose a short message. Also, it is indexed by Google in real-time which means that it is a good place to look for breaking news. You may see news from emergency managers and first responders before an event has been covered by journalists. Just remember that the information isn’t fact-checked the way a news article would be. Many government institutions are now using it, and tweets are being archived by the Library of Congress. Some institutions use Twitter to post a link to each new piece of content that they post, which makes it kind of like an RSS feed, too. You can usually find an institution’s Twitter account by looking for a blue T or a blue bird on their website—the symbols aren’t as consistent as they are for RSS.
  • Please see MLA’s “Moodle” site for the Disaster Health Information Sources: The Basics course for this list.Mention that during a disaster. You should know which agency is in charge and follow them. Talk about importance of local sources. TL I added a few Canadian feeds.
  • TaraAsk the class to fill in the blanks. CLICK to see next question. (1.) Emergency Access Initiative(2.) Surge capacity, hospital facilities disaster management, surveillance, triage, etc. (see slide 8 for complete list)(3.) HazLit, PubMed, NCBI Bookshelf(4.) CHEMM(5.) WISER(6.) CDC’s MMWR, ECDC Surveillance, WHO’s Global Alert and Response, CCDR weekly
  • TaraDon’t have to look very far or hard to find the very current information. Scholarly publications may require monitoring. H1N1 example. Value added of the librarian role to know which sites to monitor.
  • Robin
  • Tara
  • Robin
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  • [If we ave time…]Walk around the class and answer questions as they arise
  • Also mention the MLA’s Moodle page for the course.
  • Disaster Health Information Sources for Canadians

    1. Disaster Health Information Sources for Canadians: The Basics9:00 – 12:30, June 12CHLA 2012http://hlwiki.slais.ubc.ca/index.php/Disaster_Information_For_LibrariansRobin Featherstone, MLISTara Landry, MLISSlides: http://www.slideshare.net/featherr
    2. Regional Hazards Search Public Safety Canada’s Get Prepared site (http://www.getprepared.gc.ca/) to identify hazards in your province.
    3. Publications on disaster topics 9/11 Katrina Haiti Graph created using GoPubMed: http://www.gopubmed.org/
    4. Publications on disease outbreaks H1N1 SARS Avian Flu Graph created using GoPubMed: http://www.gopubmed.org/
    5. H1N1 Cases: March 15 to April 26, 2009
    6. H1N1 Cases: March 15 to April 26, 2009 Timeline created using dipity: http://www.dipity.com/
    7. ObjectivesBy the end of the course, you will: Be comfortable locating disaster health information Be confident using a variety of disaster health databases, tools and websites Be knowledgeable about initiatives and technologies for accessing disaster health information
    8. Agenda Intro - Disaster Medicine & Disaster Workforce Case Discussion Disaster Literature Search Exercises BREAK NLM Resources for Disaster Health Information Search Exercises Tools – Apps, Email Lists, RSS, Widgets Summary Practice Exercises
    9. What is a Health Disaster? A precipitous or gradual decline in overall health status of a community for which the community is unable to cope without outside assistance. WADEM, 2003
    10. Related Terms Disaster: a serious disruption of the functioning of society, causing widespread human, material or environmental losses which exceed the ability of affected society to cope using only its own resources. Emergency: a situation that is out of control and requires immediate attention. Event: an occurrence that has the potential to affect living beings and/or their environment; a realization of a hazard. IDNDR, 1992 http://www.wadem.org/guidelines/glossary.pdf WADEM, 2003
    11. Disaster Medicine: An OverviewResearch & Epidemiology Public Health & Emergency Specific Disasters Management Systems-Education & training -Legislation & regulations -Traumatic & explosive-Surge capacity -Surveillance events-Ethics -Triage -Chemical events-International perspectives -Protective equipment -Biological events-Emerging infectious diseases -Decontamination -Nuclear & radiological-Mental & behavioral health -Distribution of medications events -EMS scene management -Hazmat, toxic & industrial -Hospital facility disaster events management -Floods -Mortuary services -Hurricanes -Telemedicine & telehealth -Tornados -Patient identification & -Earth quakes tracking -Tsunami -Winter storms -Heat wavesKoenig & Schultz, 2010 -Volcanoes
    12. Disaster WorkforceLicensed or trainedPaid or volunteerPermanent or as-needed workers … who play a defined role in… All-hazards preparedness, response and recovery In implementing Emergency Support Function 5: Public Health and Essential Human Services
    13. Case discussion : PandemicAt the end of April, 2009, an administrator from a hospital critical incident planning team asks you to find information to answer the question:What is the effectiveness of antiviral agents for H1N1? What are some specific challenges related to finding information in this case? How would you approach this question?
    14. Disaster Health InformationPeer-reviewed scholarly literature• Journal articles• Books“Grey” Literature• Reports• Summaries• Surveillance data• Training materials• Conference proceedings
    15. Disaster Literature - Journals • American Journal of Disaster Medicine • Canadian Journal of Emergency Medical Care • Disasters • Disaster Management and Response • Prehospital and Disaster Medicine • Biosecurity and Bioterrorism •Journal of Business Continuity and Emergency Planning
    16. Describing Disaster Medicine LC subjects  Disaster Medicine  Disaster hospitals  Disaster nursing MeSH - http://sis.nlm.nih.gov/dimrc/mesh_disaster.html DIMRC’s Disaster Glossaries: http://sis.nlm.nih.gov/dimrc/glossaries.html No Doody’s category for “disaster medicine” – try instead:  Emergency Medical Services  Emergency Medicine  Public Health WorldCat categories  Emergency Medical Services  Emergency Management  Emergencies  Disaster Planning  Disaster Medicine (>1000 books)
    17. NLM’s Emergency Access Initiative • Provides free access to full- text articles from biomedical journals and reference books for areas affected by disasters • Activated for Haiti earthquake, Gulf oil spill, floods in Pakistan, and the recent disasters in Japan • Partnership with publishershttp://eai.nlm.nih.gov • 200+ journal titles • 30+ reference books
    18. Exercise: Information for ProfessionalsA child psychiatrist asks you to find articles to answer the question: What is the post-hurricane pattern of behavioural and emotional problems in children?1. PubMed: http://www.ncbi.nlm.nih.gov/pubmed2. NCBI Bookshelf: http://www.ncbi.nlm.nih.gov/books3. NCTSN (National Child Traumatic Stress Network): http://www.nctsnet.org/
    19. Exercise: Information for ProfessionalsFind documents outlining procedures for preparing hospitals for an earthquake1. DIMRC (Disaster Information Management Research Center) - Resource Guide for Disaster Medicine and Public Health: http://disasterlit.nlm.nih.gov/2. Cochrane Evidence Aid: http://www.cochrane.org/cochrane-reviews/evidence-aid-project3. PAHO (Pan American Health Organization) – Area on Emergency Preparedness and Disaster Relief: http://new.paho.org/disasters/4. PubMed: http://www.ncbi.nlm.nih.gov/pubmed
    20. Professional Information - Federal ASPR’s (Office of the Assistant Secretary for Preparedness and Response) Public Health Emergency http://www.phe.gov/ CDC’s Emergency Preparedness and Response – Pages for Professionals http://emergency.cdc.gov/ Public Health Agency Canada : Emergency Preparedness and Response http://www.phac-aspc.gc.ca/ep-mu/index-eng.php Public Health Agency Canada: Canadian Disaster Database http://cdd.publicsafety.gc.ca/srchpg-eng.aspx?dynamic=false
    21. Professional Information – Associations American Academy of Pediatrics http://www2.aap.org/disasters/ American College of Emergency Physicians http://www.acep.org/practres.aspx?id=30194 Canadian Red Cross http://www.redcross.ca/ World Association for Disaster and Emergency Medicine http://www.wadem.org/
    22. Professional Information – Academic Center for Biosecurity at the University of Pittsburgh Medical Center http://www.upmc-biosecurity.org/ Center for Infectious Disease Research & Policy (CIDRAP) http://www.cidrap.umn.edu/ Center for the Study of Traumatic Stress http://www.centerforthestudyoftraumaticstress.org/ Disaster Research Center at the University of Delaware http://www.udel.edu/DRC/ http://dspace.udel.edu:8080/dspace/handle/19716/35 Public Safety Canada – Canadian Emergency Management College http://www.publicsafety.gc.ca/prg/em/cemc/index-eng.aspx
    23. Exercise: Disaster Health Information for thePublic Use the following resources to find information on health hazards after a flood for a consumer audience. 1. CDC 2. Getprepared.gc.ca 3. MedlinePlus
    24. Surveillance ExerciseFind recent incidence figures for Influenza CDC – MMWR State Health Statistics: http://www.cdc.gov ECDC – Surveillance: http://ecdc.europa.eu WHO – Global Alert and Response: http://www.who.int/en PHAC – Public Health Agency Canada: http://www.phac-aspc.gc.ca/index-eng.php
    25. Break
    26. NLM’s Disaster Information Tools & Mobile Applications: WISER  For HazMat (hazardous materials) / CBRN (chemical, biological, radiological, and nuclear) events  Designed for: First responders (fire fighters), HazMat teams, EMS/Paramedics, Emergency Department personnel  Stand-alone and enhancedhttp://wiser.nih.nlm.gov (wireless) capabilities  Training materials available: http://wiser.nlm.nih.gov/training.html
    27. NLM’s Disaster Information Tools & Mobile Applications: WISER HazMat/CBRN InformationIncludes: Substance properties Chemical identification tool Procedures for emergency responders Medical treatment data Safe protective distance mapping - GIS
    28. WISER Exercise1. Search WISER http://wiser.nlm.nih.gov/ to answer the question:What type of personal protective equipment (PPE) & protective distance is required for a large spill of xylenes?
    29. NLM’s Disaster Information Tools & Mobile Applications: REMM  Radiation Emergency Medical Management  For health care workers diagnosing and treating patients during radiological/nuclear events  Provides evidence-based information for those without formal radiation medicine expertise  Stand-alone application available on many platformshttp://remm.nlm.gov/ and mobile devices
    30. REMM Exercise: http://remm.nlm.gov1. Search REMM to find out how to perform a survey for radiation contamination2. Search REMM to answer the question:What is the treatment for a patient who presents with no injuries and was exposed to radiation at 9:00 today and began vomiting at 15:00?
    31. NLM’s Disaster Information Tools & Mobile Applications: CHEMM  Chemical Hazards Emergency Medical Management  For first responders, first receivers, other healthcare providers, and planners  Contains information to plan for, respond to, recover from, and mitigate the effects of incidents involving chemicals  Content can be downloaded to your computerhttp://chemm.nlm.nih.gov/  Includes identification tools and medical management guidelines for chemical groups and syndromes
    32. CHEMM Exercise:http://chemm.nlm.nih.gov/1. Search CHEMM to answer the question:Identify the syndrome for an unconscious patient who has been exposed to an unknown chemical and presents with pinpoint pupils, arrhythmia and is sweaty?2. What is the recommended treatment for this patient in the emergency department?
    33. Role of Social Media “Clearly, social media are changing the way people communicate not only in their day-to-day lives, but also during disasters that threaten public health.” (Merchant, 2011)
    34. Stay Informed Apps Email Lists RSS (Really Simple Syndication) Twitter
    35. Stay Informed – Apps Disaster Apps and Mobile Optimized Web Pages: http://sis.nlm.nih.gov/dimrc/disasterapps.html Relief Central  Free mobile and web resource  To assist relief workers, first responders, and others called to serve in disaster relief situations around the world
    36. Stay Informed – Email Lists CDCs Healthcare Preparedness Info list: https://service.govdelivery.com/service/subscribe.html?code=U SCDC_512 DIMRC’s DISASTR-OUTREACH-LIB: http://sis.nlm.nih.gov/dimrc/dimrclistserv.html ISID’s ProMED-Mail: http://www.promedmail.org/
    37. Stay Informed – RSS
    38. Stay Informed – RSS CDC: http://www2c.cdc.gov/podcasts/rss.asp  Contains dozens of RSS feeds on disaster topics  Includes the MMWR CCDR Weekly: http://www.phac-aspc.gc.ca/rss/ccdr-rmtc-eng.xml  national and international information about communicable disease incidents and issues ECDC: http://ecdc.europa.eu/en/Pages/rssfeeds.aspx  Includes epidemiological updates, influenza surveillance data and other public health news NLM: http://sis.nlm.nih.gov/sisrssfeed.html  Includes updates from NLM’s division of Specialized Information Services, which includes DIMRC WHO: http://www.who.int/about/licensing/rss/en/  Contains Disease Outbreak, and Emergencies and Disasters news feeds
    39. Stay Informed – Twitter  Twitter subscribers receive real-time updates  140 character maximum  Look for the blue bird or the blue “t” on websites to find an institution’s twitter account  Used by many disaster health information providers…
    40. Stay Informed – TwitterUS Government International USAID - @USAID  American Red Cross - @RedCross FEMA - @fema  IFRC - @Federation CDC Emergency - @CDCemergency  WHO News - @whonews NACCHO - @NACCHOalerts  PAHO Disasters Area - NLM DIMRC - @NLM_DIMRC @PAHOdisasters US EPA Web - @EPAweb  PAHO/WHO Equity - @eqpaho FluGov - @FluGov  WHO/PAHO EOC - @pahoeoc ASPR - @PHEgov  ReliefWeb - @reliefweb StateDept - @StateDept OthersCanadian Government  Doctors w/o Borders - PHAC - @phac_gc @MSF_CANADA  CrisisCommons - @CrisisCommons Public Safety Canada - @safety_canada  Crisis Social Media - @CrisisSocMed  Natural Hazards Center - @HazCenter  Crisis Mappers - @CrisisMappers
    41. Stay Informed – TwitterCommon emergency management hash tags#HSEM Homeland Security Emergency Management#Outbreak Disease Outbreak#CBRNE Chemical, Biological, Radiological, Nuclear and Explosive#Hazmat Hazardous Materials#SMEM Social Media Emergency Management#Twoat Tropical Weather Outlook Atlantic… and many more. See:http://davislogic.blogspot.com/2011/08/twitter-hashtags-and-emergency.html
    42. Summary NLM’s ________ gives free access to literature to areas affected by disasters. Some topics under the subject “Disaster Medicine” include _________, _________, __________. Use ________ to find peer-reviewed journal articles and books on disaster health topics. _________ includes diagnostic information for chemical exposure? First responders use ________ to identify unknown toxic agents. _________ are examples of a surveillance tools.
    43. Key Points1. An influx of information and research interest will commonly occur shortly after a major disaster.Be prepared to answer questions and consider using tools like RSS and email lists to monitor information as it is being produced.
    44. Key Points2. The “disaster workforce” is very large and contains both licensed professionals and volunteers.Consider using sources for both a professional and public/consumer audience when proving disaster health information.
    45. Key Points3. There are more “Grey Literature” sources of disaster health information than peer-reviewed, indexed sources.Use a combination of bibliographic databases, federal websites and aggregators, surveillance tools, professional associations, and academic centers to locate disaster health literature.
    46. Key Points4. NLM’s tools contain specialized information for first responders and receivers.Consider the nature of the disaster/emergency when recommending a tool. WISER for Haz/Mat, CBRNE REMM for radiological CHEMM for chemical
    47. Key Points5. Social software is revolutionizing the method of delivering disaster health information.Use apps, email lists, RSS, & Twitter to stay informed.
    48. Practice Exercises Answer the question: What are recommendations regarding hospital oxygen supplies for an influenza pandemic? Find recent incidence figures for cholera Find consumer information on the health effects of wild fires Answer the question: How do you diagnose for wound contamination from radioactive shrapnel? Find best evidence on facemask use by children during respiratory infectious disease outbreaks Find information on developing an all hazards preparedness training program on medical surge. Answer the question: What are guidelines for setting up a chemical decontamination area outside a hospital emergency department? Answer the question: What disaster triage category should be assigned to a patient who cannot walk, exhibits spontaneous breathing and a respiratory rate greater than 30?
    49. References & Further ReadingBarbisch, D., Haik, J., Tessone, A., & Hanfling, D. (2010). Surge Capacity. In Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practice. New York: Cambridge University Press. 33-49.CDC. (2011). Preparedness for All Hazards. Accessed August 13, 2011 from: http://www.bt.cdc.gov/hazards-all.aspDMORT (Disaster Mortuary Operational Response Teams). (2011). Who Makes Up a DMORT Team? Accessed August 13, 2011 from: http://www.dmort.org/DNPages/DMORTPeople.htmESAR-VHP (The Emergency System for Advance Registration of Volunteer Health Professionals). (2011). Who is Eligble? Accessed August 13, 2011 from: http://www.phe.gov/esarvhp/pages/registration.aspxIDNDR (International Decade of Natural Disaster Reduction). 1992. Internationally agreed glossary of basic terms.Kaji, A., Koenig, K., Bey, T. (2006). Surge capacity for healthcare systems: a conceptual framework. Acad Emerg Med. 13(11). 1157- 1159.Koenig, K.L., & Schultz, C.H, (Eds.). (2010). Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practice. New York: Cambridge University Press.Merchant, R.M., Elmer, S. & Lurie, N. (2011). Integrating Social Media into Emergency-Preparedness Efforts. NEJM. 365(4). 289- 291.Public Safety Canada (2011). ANNEX A - Emergency Support Functions (ESFs). Accessed March 13, 2012 from: http://www.publicsafety.gc.ca/prg/em/ferp-eng.aspx#a52Turoff, M., & Hiltz, S. R. (March 6, 2008). Information Seeking Behavior and Viewpoints of Emergency Preparedness and Management Professionals Concerned with Health and Medicine. Report prepared for the National Library of Medicine. Accessed April 8, 2012 from: http://web.njit.edu/~turoff/Papers/FinalReportNLMTuroffHiltzMarch11.htmWADEM (World Association for Disaster and Emergency Medicine). (2003). Glossary of Terminology. In Health Disaster Management: Guidelines for Evaluation and Research. Vol. 1. Madison: Prehospital and Disaster Medicine. Accessed September 8, 2011 from http://www.wadem.org/guidelines/glossary.pdfYong, E. (2011). Disease Trackers. BMJ. 343(7814). 70-71.
    50. Photo Credits*F5 tornado Elie Manitoba 2007 by Justin1569 at en.wikipedia: http://commons.wikimedia.org/wiki/File:F5_tornado_Elie_ Manitoba_2007.jpgGDE Bridge Collapse by Richard, Enzyme05’s photostream: http://commons.wikimedia.org/wiki/File:GDE_Bridge_Colla pse.jpgInondations 2011 St-Jean-sur-Richelieu by Helene, Boréal/Images’ photostream: http://commons.wikimedia.org/wiki/File:Inondations_2011_St-Jean-sur- Richelieu.jpgTamiflu NOR by KEN: http://commons.wikimedia.org/wiki/File:Tamiflu_NOR.JPG * Public domain image files downloaded from Wikimedia Commons. Attribution given as indicated by creators where applicable.
    51. Questions