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Since the 2014 Ebola outbreak many public- and private-sector
leaders have seen a need for improved management of global public
health emergencies. The effects of the Ebola epidemic go well
beyond the three hardest-hit countries and beyond the health
sector. Education, child protection, commerce, transportation, and
human rights have all suffered. The consequences and lethality of
Ebola have increased interest in coordinated global response to
infectious threats, many of which could disrupt global health and
commerce far more than the recent outbreak. In order to explore the
potential for improving international management and response to
outbreaks the National Academy of Medicine agreed to manage an
international, independent, evidence-based, authoritative,
multistakeholder expert commission. As part of this effort, the
Institute of Medicine convened four workshops in summer of 2015 to
inform the commission report. The presentations and discussions
from the Workshop on Resilient and Sustainable Health Systems to
Respond to Global Infectious Disease Outbreaks are summarized in
this report. Table of Contents Front Matter 1 Introduction 2
Fundamental Principles of Strong Health Systems 3 Health Systems
Strengthening: Building Day-to-Day Care and Public Health
Capacities 4 Strengthening Information Management Systems 5
Strengthening Outbreak Management and Emergency Response Systems 6
Closing Remarks Appendix A: References Appendix B: Statement of
Task Appendix C: Agenda Appendix D: Speaker Biographies
When disaster strikes, it rarely impacts just one jurisdiction.
Many catastrophic disaster plans include support from neighboring
jurisdictions that likely will not be available in a regional
disaster. Bringing multiple stakeholders together from sectors that
do not routinely work with each other can augment a response to a
disaster, but can also be extremely difficult because of the
multi-disciplinary communication and coordination needed to ensure
effective medical and public health response. As many communities
within a region will have similar vulnerabilities, a logical step
in planning is to establish responsibilities and capacities, and be
able to work toward common goals to address all-hazards when the
entire region is affected. To explore these considerations, the
Institute of Medicine's Forum on Medical and Public Health
Preparedness for Catastrophic Events organized a series of three
regional workshops in 2014 to explore opportunities to strengthen
the regional coordination required in response to a large scale
multijurisdictional disaster. The purpose of each regional workshop
was to discuss ways to strengthen coordination among multiple
jurisdictions in various regions to ensure fair and equitable
treatment of communities from all impacted areas. Regional Disaster
Response Coordination to Support Health Outcomes summarizes the
presentation and discussion of these workshops. Table of Contents
Front Matter 1 Introduction 2 Evacuation, Patient Tracking, and
Information Sharing in a Regional Response 3 Public Health Surge
Capacity and Community Resilience 4 Coordination of a Community
Response 5 Final Remarks A-- References B-- Acronyms C-- Statement
of Task D--Agendas E-- Biographical Sketches of Invited Speakers
and Panelists F-- Speakers and Registered Attendees
The most recent Ebola epidemic that began in late 2013 alerted the
entire world to the gaps in infectious disease emergency
preparedness and response. The regional outbreak that progressed to
a significant public health emergency of international concern
(PHEIC) in a matter of months killed 11,310 and infected more than
28,616. While this outbreak bears some unique distinctions to past
outbreaks, many characteristics remain the same and contributed to
tragic loss of human life and unnecessary expenditure of capital:
insufficient knowledge of the disease, its reservoirs, and its
transmission; delayed prevention efforts and treatment; poor
control of the disease in hospital settings; and inadequate
community and international responses. Recognizing the opportunity
to learn from the countless lessons of this epidemic, the National
Academies of Sciences, Engineering, and Medicine convened a
workshop in March 2015 to discuss the challenges to successful
outbreak responses at the scientific, clinical, and global health
levels. Workshop participants explored the epidemic from multiple
perspectives, identified important questions about Ebola that
remained unanswered, and sought to apply this understanding to the
broad challenges posed by Ebola and other emerging pathogens, to
prevent the international community from being taken by surprise
once again in the face of these threats. This publication
summarizes the presentations and discussions from the workshop.
Table of Contents Front Matter 1 Introduction 2 The Outbreak 3
Global Preparedness and Response Efforts 4 Current and Future
Research Opportunities Appendix A: References Appendix B: Ebola: A
View from the National Institute of Allergy and Infectious Diseases
Appendix C: Ebola Virus Disease Preparedness in Germany: Expertise
Focused in Specialized Laboratories, Competence, and Treatment
Centers Appendix D: Statement of Task Appendix E: Workshop Agenda
Appendix F: Speaker Biographies
Emerging infectious disease threats that may not have available
treatments or vaccines can directly affect the security of the
world's health since these diseases also know no boundaries and
will easily cross borders. Sustaining public and private investment
in the development of medical countermeasures (MCMs) before an
emerging infectious disease becomes a public health emergency in
the United States has been extremely challenging. Interest and
momentum peak during a crisis and wane between events, and there is
little interest in disease threats outside the United States until
they impact people stateside. On March 26 and 27, 2015, the
Institute of Medicine convened a workshop in Washington, DC to
discuss how to achieve rapid and nimble MCM capability for new and
emerging threats. Public- and private-sector stakeholders examined
recent efforts to prepare for and respond to outbreaks of Ebola
Virus Disease, pandemic influenza, and coronaviruses from policy,
budget, and operational standpoints. Participants discussed the
need for rapid access to MCM to ensure national security and
considered strategies and business models that could enhance
stakeholder interest and investment in sustainable response
capabilities. This report summarizes the presentations and
discussions from this workshop. Table of Contents Front Matter 1
Introduction 2 A Wake-Up Call: The 2014 Ebola Outbreak Response 3
Preparedness as an Issue of National Security 4 Rapid Development
of Ebola Vaccines 5 Influenza Risk Assessment and Pandemic
Preparedness 6 Developing MCMs for Coronaviruses 7 Sustainable
Business Models to Ensure Rapid and Nimble Responses 8 Supporting
MCM Development Across Threats and Funding Cycles A References B
Acronyms and Abbreviations C Statement of Task D Agenda E
Biosketches of Invited Speakers and Facilitators
Over the past decade, preparedness and response capacities of
government agencies, hospitals and clinics, public health agencies,
and academic researchers in the United States and abroad have been
challenged by a succession of public health emergencies, ranging
from radiological threats to pandemics to earthquakes. Through
After Action Reports, each of these emergencies has yielded
important information and lessons learned that can inform future
disaster response and recovery efforts. However, important
information that needs to be collected during and immediately
following these emergencies is often missed because of barriers and
obstacles to gathering such data, such as varying institutional
review board restrictions in different states, no sustainable
funding network for this type of work, uncertainty on who should be
involved in research response, and a lack of knowledge around how
best to integrate research into response and recovery frameworks.
Taking action to enable medical and public health research during
disasters was the focus of a workshop held on June 12 and 13, 2014,
coordinated and supported jointly by the Institute of Medicine
Forum on Medical and Public Health Preparedness for Catastrophic
Events, National Institute of Environmental Health Sciences, the
National Library of Medicine, the U.S. Department of Health and
Human Services' Office of the Assistant Secretary for Preparedness
and Response, and the Centers for Disease Control and Prevention.
Invited speakers and participants from federal, state, and local
government, academia, and community and worker organizations came
together to discuss how to integrate research into existing
response structures; identify critical research needs and
priorities; identify obstacles and barriers to research; discuss
structures and strategies needed for deployment of a research
study; share ideas, innovations, and technologies to support
research; and explore data collection tools and data-sharing
mechanisms for both rapid and longitudinal research. Enabling Rapid
and Sustainable Public Health Research During Disasters summarizes
the presentations and discussion of the workshop. Table of Contents
Front Matter 1 Introduction 2 Science Preparedness: Conducting
Research During Public Health Emergencies 3 Health Research Needs
and Actions: Lessons from Recent Disasters 4 Addressing
Institutional Review Board Barriers to Health Research
Implementation 5 Partnering with the Community to Enable Research 6
Improving Data Collection Capabilities and Information Resources 7
Considerations for Rapid and Sustained Funding Mechanisms for
Research in Disasters 8 Improving the Role of Extramural Research
Networks 9 Coordinating Logistics to Execute Rapid Research in
Disaster Response 10 Actions to Build the Future of Disaster
Research Appendix A: References Appendix B: Acronyms Appendix C:
Agenda Appendix D: Biographical Sketches of Invited Speakers and
Panelists Appendix E: Speakers and Registered Attendees Appendix F:
Statement of Task
Many of the elements of the Affordable Care Act (ACA) went into
effect in 2014, and with the establishment of many new rules and
regulations, there will continue to be significant changes to the
United States health care system. It is not clear what impact these
changes will have on medical and public health preparedness
programs around the country. Although there has been tremendous
progress since 2005 and Hurricane Katrina, there is still a long
way to go to ensure the health security of the Country. There is a
commonly held notion that preparedness is separate and distinct
from everyday operations, and that it only affects emergency
departments. But time and time again, catastrophic events challenge
the entire health care system, from acute care and emergency
medical services down to the public health and community clinic
level, and the lack of preparedness of one part of the system
places preventable stress on other components. The implementation
of the ACA provides the opportunity to consider how to incorporate
preparedness into all aspects of the health care system. The
Impacts of the Affordable Care Act on Preparedness Resources and
Programs is the summary of a workshop convened by the Institute of
Medicine's Forum on Medical and Public Health Preparedness for
Catastrophic Events in November 2013 to discuss how changes to the
health system as a result of the ACA might impact medical and
public health preparedness programs across the nation. This report
discusses challenges and benefits of the Affordable Care Act to
disaster preparedness and response efforts around the country and
considers how changes to payment and reimbursement models will
present opportunities and challenges to strengthen disaster
preparedness and response capacities. Table of Contents Front
Matter 1 Introduction 2 How the ACA Will Change the Health Care
Delivery System 3 Preparedness Impacts of the Changes to Health
Care System Financing and Delivery Infrastructure 4 The Evolving
Health Workforce 5 Needs and Logistics of Data Sharing and Health
Information Technology 6 Potential Opportunities to Enhance
Preparedness Through Health Information Exchanges and Predictive
Analytics 7 Leveraging the Affordable Care Act and Information
Technology to Innovate 8 The Continuing Role for Public Health
Preparedness and Response Appendix A: References Appendix B:
Acronyms Appendix C: Statement of Task Appendix D: Agenda Appendix
E: Biographical Sketches of Invited Speakers and Panelists Appendix
F: Key Features of the Affordable Care Act by Year
Preparedness, Response and Recovery Considerations for Children and
Families is the summary of a workshop convened in June, 2013 by the
Institute of Medicine Forum on Medical and Public Health
Preparedness for Catastrophic Events to discuss disaster
preparedness, response, and resilience relative to the needs of
children and families, including children with special health care
needs. Traditional and non-traditional medical and public health
stakeholders from across federal, state, and local government
health care coalitions, community organizations, school districts,
child care providers, hospitals, private health care providers,
insurers, academia, and other partners in municipal planning met to
review existing tools and frameworks that can be modified to
include children's needs; identify child-serving partners and
organizations that can be leveraged in planning to improve outcomes
for children; highlight best practices in resilience and recovery
strategies for children; and raise awareness of the need to
integrate children's considerations throughout local and state
emergency plans. Communities across the United States face the
threat of emergencies and disasters almost every day, natural and
man-made, urban and rural, large and small. Although children
represent nearly 25 percent of the U.S. population, current state
and local disaster preparedness plans often do not include specific
considerations for children and families. The preparedness and
resilience of communities related to children will require a
systems framework for disaster preparedness across traditional and
non-traditional medical and public health stakeholders, including
community organizations, schools, and other partners in municipal
planning. This report examines resilience strategies that lead to
successful recovery in children after a disaster and discusses
current approaches and interventions to improve recovery in
children.
Engaging the Public in Critical Disaster Planning and Decision
Making is the summary of a workshop held in March 2013 to discuss
the key principles of public engagement during the development of
disaster plans, the response phase, and during the dissemination
phase when interested community partners and the general public are
informed of the policies that have been adopted. Presenters
provided specific examples of resources to assist jurisdictions in
planning public engagement activities as well as challenges
experienced and potential solutions. This report introduces key
principles of public engagement, provides practical guidance on how
to plan and implement a public engagement activity, and presents
tools to facilitate planning. Table of Contents Front Matter
Engaging the Public in Critical Disaster Planning and Decision
Making Appendix A: References Appendix B: Statement of Task
Appendix C: Workshop Agenda Appendix D: Biographical Sketches of
Speakers and Panelists
Our nation faces the distinct possibility of a catastrophic
terrorist attack using an improvised nuclear device (IND),
according to international and U.S. intelligence. Detonation of an
IND in a major U.S. city would result in tens of thousands to
hundreds of thousands of victims and would overwhelm public health,
emergency response, and health care systems, not to mention
creating unprecedented social and economic challenges. While
preparing for an IND may seem futile at first glance, thousands of
lives can be saved by informed planning and decision making prior
to and following an attack. In 2009, the Institute of Medicine
published the proceedings of a workshop assessing the health and
medical preparedness for responding to an IND detonation. Since
that time, multiple federal and other publications have added
layers of detail to this conceptual framework, resulting in a
significant body of literature and guidance. However, there has
been only limited planning effort at the local level as much of the
federal guidance has not been translated into action for states,
cities and counties. According to an informal survey of community
preparedness by the National Association of City and County Health
Officials (NACCHO), planning for a radiation incident ranked lowest
in priority among other hazards by 2,800 local health departments.
The focus of Nationwide Response Issues After an Improvised Nuclear
Device Attack: Medical and Public Health Considerations for
Neighboring Jurisdictions: Workshop Summary is on key response
requirements faced by public health and health care systems in
response to an IND detonation, especially those planning needs of
outlying state and local jurisdictions from the detonation site.
The specific meeting objectives were as follows: - Understand the
differences between types of radiation incidents and implications
of an IND attack on outlying communities. -Highlight current
planning efforts at the federal, state, and local level as well as
challenges to the implementation of operational plans. -Examine
gaps in planning efforts and possible challenges and solutions.
-Identify considerations for public health reception centers: how
public health and health care interface with functions and staffing
and how radiological assessments and triage be handled. -Discuss
the possibilities and benefits of integration of disaster transport
systems. -Explore roles of regional health care coalitions in
coordination of health care response.
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