emergency public health & disaster medicine
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Emergency Public Healthand
Disaster MedicineBobby Kapur, M.D., M.P.H.
Associate Professor of Medicine & PediatricsAssociate Chief for Academic Affairs
Section of Emergency Medicine
Emergency Public Health 2
1. Present the scope & impact of Public Health Emergencies
2. Define the concept of Emergency Public Health3. Differentiate Emergency Public Health from
Disaster Medicine4. Show how Emergency Public Health can lead to
Public Health Security
Objectives
Emergency Public Health 3
Public Health Emergencies
Scope of Problem
Baylor College of Medicine 4
Natural Public Health Emergencies
Sichuan EarthquakeMay 19, 2008
Emergency Public Health 5
Industrial Public Health Emergencies
BP Gulf of Mexico Explosion
April 20, 2010
Emergency Public Health 6
Infectious Disease Public Health Emergencies
Emergency Public Health 7
Terrorism Public Health Emergencies
9/11/2001
Emergency Public Health 8
Emergency Public Health 9
Increasing Threats to Cities
Number of Declared US Disasters 1988-2008
(Source: Data from FEMA http://www.fema.gov/news/disaster_totals_annual.fema)
Emergency Public Health 10
Increasing Densities of Cities
Current and Projected Percentage of Global Population Living in Urban Areas
(Source: Data from UN. http://esa.un.org/unup/index.asp?panel=1)
Emergency Public Health 11
Emergency Public Health
New & Emerging Field
Emergency Public Health 12
Emergency Public Health: A New Concept
• New field of academic study• “Public Health” approach to large-scale
emergencies and crises• Population-based analysis
Emergency Public Health 13
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
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Disasters: Causes?
Emergency Public Health 15
Disaster Cycle
Hazard
Emergency Public Health 16
Emergency Public Health vs. Disaster Medicine
Emergency Public Health differs from Disaster Medicine because it encompasses more than
just the management of specific hazards.
Emergency Public Health 17
Emergency Public Health and the Disaster Cycle
Hazard
Epidemiology
Rapid NeedsAssessment
Surveillance & Monitoring
Emergency Public Health 18
Emergency Public Health vs. Disaster Medicine
Hazard
Patients
Govt:EMSFire
Police Hosps
Private Sector
NGOs
Public Health LawTechnology
EpidemiologyRapid Needs AssessmentsSurveillanceMonitoring
DisasterMedicine
EmergencyPublic Health
AcadCenters
Emergency Public Health 19
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
Emergency Public Health 20
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
Emergency Public Health 21
Emergency Public Health
Public Health Security
Emergency Public Health 22
Emergency Public Health 23
Public Health Security Framework
Emergency Public Health 24
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
Emergency Public Health 25
Resilience Analysis Model
Emergency Public Health 26
Emergency Public Health
Government & Public Health Emergencies
Emergency Public Health 27
National Government
Institute of Medicine (IOM) states there are 6 major roles of the government in public health: 1.Policy 2.Finance3.Public health protection4.Information gathering and dissemination5.Capacity building6.Direct patient health care services
Emergency Public Health 28
National Response Framework
Emergency Public Health 29
Key Components of Mutual Aid Agreements
Interoperabilityof Communications
Credentialing of
Responders
Financial Responsibilities
Procedures for Requesting
Resources and Personnel
Command and Control of Personnel
and ResourcesLiability
(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.)
Emergency Public Health 30
Public Health Law
Emergency Public Health 31
Emergency Public Health 32
Emergency Public Health
Non-Government Sector
Baylor College of Medicine 33
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
Emergency Public Health 34
Emergency Public Health 35
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.
Emergency Public Health 36
Emergency Public Health
Public Health Tools
Emergency Public Health 37
• Epidemiological Studies• Rapid Needs Assessments• Surveillance & Monitoring• Evaluation Processes
Emergency Public Health: Public Health Tools
Emergency Public Health 38
Epidemiology in Public Health Emergencies
Emergency Public Health 39
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
Emergency Public Health 40
Rapid Needs Assessments: Cluster Sampling
Emergency Public Health 41
Feedback Mechanisms
•Surveillance•Monitoring•Evaluation
Professionalization of responding and managing public health emergencies.
Emergency Public Health 42
WHO Framework for Surveillance
Emergency Public Health 43
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
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