Medical and Public Health Preparedness Strategies and Response Capabilities
Situation Awareness (Related to Medical Response)
Johns Hopkins University
Mt. Washington Campus
5801 Smith Avenue
Davis Building, Suite 3220
Baltimore, Maryland 21209
Tel: 410- 735-6450
Gabor D. Kelen, M.D. Director, PACER
Lauren Sauer, M.Sc. Program Manager, PACER
The National Center for the Study of Preparedness and Catastrophic Event Response (PACER) is improving the nation's preparedness and ability to respond to disasters through rigorous scientific research focused on medical and public health preparedness strategies, response capabilities, and surge capacity. PACER's research portfolio includes modeling and simulation, development of decision support tools, bio-surveillance and diagnosis, interviews and surveys, and education initiatives.
Surge Capacity Metrics
Medical surge capacity has been an important concern for contingency planners. Homeland Security Presidential Directive (HSPD)-21 directly raises this concern. The purpose of this study is to translate the most up to date science on surge capacity into a functional tool - in this case an applet that allows its user to estimate surge capacity for a given hazard in a given medical facility. Since the end-user has control over the input variables, the effect of certain operational tactics and strategies on augmentation or degradation of surge capacity can be ascertained. This control also provides the end product with adaptability that could inform various other sectors. This allows the facility to plan a stepwise phased implementation of surge response as dictated by the size of the surge.
This project will build on the work that was completed during project A-1 of PACER I. In project A-1, PACER researchers were able to form consensus on a comprehensive list of variables in four categories that may influence and alter surge capability within a health care system. During PACER II, additional literature reviews, use of the conclusions of the PACER I consensus , and a follow-up expert panel convention will allow PACER researchers to select the key variables form amongst hundreds identified, that are both readily measured and most contribute to the capacity prediction. The resulting key variables will ultimately inform the algorithm.
Society for Disaster Medicine
The establishment of a Society for Disaster Medicine is critical to the promotion of the field and the development of its interests. This society is inclusive of all fields related to disaster health including medicine, public health, nursing, EMS, first responders, etc. The Society for Disaster Medicine aims to serve and promote these fields as well as offer opportunities for education and training. The founding members have been identified through their active roles in the Disaster Health field and include physicians, researchers, nurses, other clinicians and policy makers.
A critical component of emergency preparedness is the ability to predict the health surge influence , such as casualty estimates, of various hazard scenarios and the subsequent ability of a region to meet medical demands . PACER's tool, the Electronic Mass Casualty Assessment and Planning Scenarios (EMCAPS) Version 1.0, is a scalable program intended to support emergency preparedness planning efforts at multiple levels. This computerized modeling simulation program allows users to manipulate key scenario-based input variables that best reflect the region or locale of interest. The program provides output data which can be used to assess and tailor response capabilities for specific jurisdictions, organizations, and health care systems.
A new version of EMCAPS (V2.0) project seeks to expand the tool and make the program more accessible, interactive, and instructive. This new version will provide users greater flexibility in tailoring a scenario to their particular location, with additional scenarios to choose from, as well as more variables for manipulation within each scenario.
Disaster Triage Tool
This tool seeks to improve hospital surge capacity by developing a rapid evidence-based tool to predict appropriate level of in-hospital care using emergency department information. Patients triaged to inadequate levels of care are placed at higher risk. Patients triaged to excessively high levels of care receive no added benefit and consume limited critical care resources.
Examination of Resilience and Role Conflict among Fire/Emergency Medical Service Personnel in the Midst of Disaster
In the event of a manmade or natural disaster, police, fire, and emergency medical service (EMS) personnel are essential front-line first responders. The ability of police, fire, and EMS agencies to provide adequate services is contingent upon critical response personnel working and functioning in an efficient manner. Currently, it is assumed that first responders will continue to work in the event of a disaster, even if they are personally impacted by the disaster to which they are expected to respond. However, first responders are susceptible to the same fears and concerns as the general public when they and their loved ones are personally impacted by a disaster. This project will provide information on what can be expected from those whom society relies upon in the midst of a disaster -- police, fire and emergency medical service (EMS) personnel-- when they are personally impacted by the catastrophe to which they are responding. Specifically, the project examines issues and concerns that may impede professional response, as well as the coping strategies that foster resilience among first responders during a disaster. The project examines these issues among police, fire, and EMS personnel who served as first responders during the Hurricane Katrina crisis in New Orleans, Louisiana and Gulfport, Mississippi (2005), and the earthquake in Santiago, Chile (2010).
High Performance Agent-Based Models for Catastrophic Event Preparedness
We conduct National and Planetary Scale agent-based computational modeling of infectious diseases (H1N1) and the effect of containment strategies including vaccination, school closures, anti-viral prophylaxis, and travel restrictions. In developing modeling tools for the full spectrum of decision makers to evaluate alternative emergency policies and actions, and anticipate cascading effects across interdependent systems, our work aligns with the IGD and DHS Biennial priority area Modeling and Simulation for Decision Support Systems. We also apply the hybrid Computational Fluid Dynamics / Agent-Based Modeling platform pioneered in PACER to design evacuation strategies for large cities given the release of airborne toxic contaminants (chemical, biological). This involves unparalleled visualization of toxic plume dynamics and traffic patterns projected on a realistic 3-Dimenisonal renditions of Los Angeles and New Orleans. The Global Scale Agent Model developed in PACER to simulate pandemic flu also represents the cutting edge of visualization in its area. We are building realistic human behaviors such as vaccine refusal into the modeling of disaster preparedness and containment planning for these and other catastrophic events. These tools offer real-time decision support in emergencies by integrating and assimilating multiple types of information, processing that information, and presenting it in a manner useful to decision makers. Two models currently under development are the Inter-Region Epidemic Dynamics (IRED) Model, which simulates the spread of contagious disease throughout a large multi-patch region like the United States, and a user-friendly desktop version of the Interactive Large Scale Agent Model (ILSAM), representing the state-of-the-art in epidemic simulation. ABMs are uniquely helpful when evaluating matters of public policy because candidate policy decisions can be implemented directly and visualized in the model. The software IRED model will be ideal for evaluating the impact of government-imposed travel restrictions or endogenous changes in travel behavior and the ILSAM will be an invaluable tool for optimizing disease interventions, as well as for training public health professionals at various levels (national, regional) with a flexible and intuitive Graphical user Interface (GUI).
Validation of the T5000/PLEX-ID for system for the identification of etiologic agents of respiratory infection
Febrile illnesses account for 10-20% of visits to emergency departments (ED). For many patients, fever represents a self-limiting and benign process. Occasionally, serious bacterial or viral respiratory tract infections may be present which can cause life threatening complications or death. The infectious agent may be one of a number of commonly occurring pathogens acquired in the community, or less frequently an atypical agent, or an emerging biothreat (BT) pathogen. Of increasing concern, as well, is the potential patient who presents to the ED with a respiratory febrile illness who may be infected with a BT agent. Prompt directed therapy based on an identified pathogen is critical for optimizing patient outcome, and protecting public concerns. Unfortunately, front line clinicians are currently limited in their ability to rapidly and reliably identify infectious agents. Bacterial and viral culture, the current "gold standard" assays for pathogen identification, is restricted by significant delays in reporting of results (24-48 hours for bacteria and even longer for viruses), and has relatively low sensitivity. These limitations result in physicians waiting for results of tests, or initiating empiric therapy. Potential problems associated with this approach include delayed treatment, improper choice of therapeutic agent, unnecessary use of antibiotics, and development of antibiotic resistance. In the case of atypical, emerging and BT agents, improper or delayed diagnosis has added costs associated with contagion and delayed recognition and management of public health threats. Molecular based diagnostic methods have shown repeatedly to be able to detect and identify various respiratory pathogens, including bacteria, viruses and potential BT agents. Use of molecular based diagnostics potentially facilitates ED physician decision to direct appropriate therapy for the most severe cases, particularly in the instance of a potential BT event. The primary objective of this study is to evaluate the ability of the Ibis Biosciences/Abbott Molecular T5000/PLEX-ID diagnostic platform to accurately and rapidly detect and identify bacterial, fungal, and viral pathogens associated with respiratory disease, in various complex clinical samples.
Emergency departments supply the critical infrastructure to provide medical care in the event of a disaster or disease outbreak, including seasonal and pandemic influenza. Already over-crowded and stretched to near-capacity, the increased patient volumes during a typical influenza season lead to emergency department crowding, and the high patient volumes expected during a true influenza pandemic represents a significant threat to the nation's healthcare infrastructure. Emergency departments ability to manage both seasonal and pandemic influenza surges is dependent upon coupling early detection with graded rapid response, a fundamental principle of infectious disease outbreak control. While extensive research and investment has been directed towards developing syndromic surveillance systems for infectious disease preparedness, there is a conspicuous absence of data demonstrating improved outcomes in medical systems attributable to syndromic surveillance. This study validates the use of a novel internet-based influenza surveillance system, and demonstrates the link between this surveillance signal, and influenza-related healthcare complications, such as emergency department crowding. Next, this study establishes a unified strategic response plan to impact emergency department crowding, and links the implementation of this response plan to triggers from the internet-based influenza surveillance system.
The PACER Summer Scholars Program seeks to recognize students with demonstrated interest in the field of disaster preparedness and catastrophic event response who exhibit exceptional merit, leadership, and integrity. These awards will enable students to participate in ground-breaking scientific research related to preparedness theory, practice, and training; analysis, modeling, and simulation; public health and medical surge capacity and the science of preparedness education. The aim of the PACER Scholarship is to introduce promising students to the cutting edge of disaster preparedness and response.
The objective of this program is to foster opportunities for students to work closely with recognized top subject matter experts in conducting research that will further the science of preparedness. It is anticipated that this program will facilitate the development of future leaders within the field of disaster preparedness and catastrophic event response as awardees are expected to establish and strengthen longer-term contacts in key scientific areas.
-Broadly speaking, the objectives of the program are to:
-Enable intellectually distinguished students to work with and learn from current leaders in the field;
-Help students gain an understanding and appreciation of the current status of disaster preparedness in the United State;
-Contribute to the advancement of knowledge in science of preparedness at PACER;
-Motivate the pursuit of careers in homeland security and disaster preparedness;
-Promote the personal and academic fulfillment of each student; and
-Contribute to the development of educational programs in disaster response and preparedness in PACER institutions and, via graduates, throughout the US.
For more information contact Lauren Sauer: firstname.lastname@example.org
Many centers and institutions collaborate closely with PACER on disaster planning and preparedness research and strategies.
University of Chicago
University of Tennessee
University of California, Los Angeles
University of Pittsburg
American Medical Association
University of Southern California
George Washington University
FEMA Federal Emergency Management Agency
National Environmental Services Center
Johns Hopkins University - Applied Psychics Laboratory
Department of Health and Human Services
Johns Hopkins Health System
National Institutes of Health
Kennedy Krieger Institute
National Medical Association
Chemical, Biological and Radiological Technology Alliance
American Indian Higher Education Consortium
National Congress of American Indians
National Native American Law Enforcement Association