Recent events have thrown the spotlight on infectious disease outbreak response. We developed a data-driven method, EpiGro, which can be applied to cumulative case reports to estimate the order of magnitude of the duration, peak and ultimate size of an ongoing outbreak. It is based on a surprisingly simple mathematical property of many epidemiological data sets, does not require knowledge or estimation of disease transmission parameters, is robust to noise and to small data sets, and runs quickly due to its mathematical simplicity. Using data from historic and ongoing epidemics, we present the model. We also provide modeling considerations that justify this approach and discuss its limitations. In the absence of other information or in conjunction with other models, EpiGro may be useful to public health responders. (C) 2016 The Authors. Published by Elsevier B.V.

CHDS State/Local / This thesis addresses the role of the emergency department in planning for mass casualties during an emergency. The demand on hospital emergency departments has stretched the capacity for normal operations beyond their original design. Hospital surge capacity is not only complex, but affects every hospital emergency department in the country. Factors, such as hospital bed capacity, surge levels, staffing and the use of volunteers in time of emergency, all play a critical role in the ability and accessibility of the hospital to react during times of need. The recommendations provided are based on the analysis of county, state and federal plans along with case studies that provide a varied approach to emergency preparedness and the role of the hospital, focus on some of the facets of preparedness and the immediate need for emergency planning, training/exercising and communication in hospitals across America, and specifically, in hospitals in South Carolina.

<p>Samhällets utveckling i kombination med förändringar inom hälso- och sjukvården ökar risken att drabbas av en allvarlig händelse. Hälso- och sjukvården måste därför anpassas för att kunna hantera situationer med ett stort skadeutfall, i samma utsträckning som en oväntad minskning av tillgänglig kapacitet, till exempel vårdplatsbrist. Genom att hitta svagheter i verksamheten så ökar möjligheterna att åtgärda dessa och därmed förmågan att kunna upprätthålla de ordinarie målen för vård och behandling av patienter vid en allvarlig händelse. Syftet med denna studie var att utveckla och testa en arbetsmetod för att systematiskt kunna analysera och utvärdera katastrofmedicinsk beredskap, samt identifiera, orsaksbestämma, åtgärdsanalysera och mäta förmågan att hantera de för Landstinget i Östergötland (LiÖ) väsentliga områdena av katastrofmedicinskt beredskap. För detta ändamål utvecklades en arbetsmetod genom att kombinera en av Katastrofmedicinskt Centrum skapad strukturmall med den metod som Patientsäkerhetsenheten inom LiÖ använder sig av vid riskanalyser. Strukturmallen utgår ifrån Socialstyrelsens föreskrifter och allmänna råd (2005:13) om vad Hälso- och sjukvården särskilt bör uppmärksamma i relation till vad dess verksamhet skall baseras på. Resultatet visar att strukturmallen i kombination med patientsäkerhetsmetoden ger möjlighet att systematiskt utföra riskanalyser inom de identifierade områdena av katastrofmedicinsk beredskap. Arbetsmetoden bidrog till en samsyn om olika begrepps betydelse, samt identifiering och värdering av för den katastrofmedicinska beredskapen förekommande risker. En fortsatt utveckling av metoden krävs för att kunna analysera och utvärdera effekter av riskminskande åtgärder.</p> / <p>The aim of the study was to develop and test a new methodology for a systematic analysis of disaster preparedness in the County Council of Östergötland. The aim was also to identify, categorise and create measurability of the surge capacity within important fields of the disaster preparedness of the County Council of Östergötland.</p><p>The methodology is based on the use of a template developed by the Centre for Teaching and Research in Disaster Medicine and Traumatology (KMC), in combination with a validated patient risk assessment tool. The KMC template is based on national regulations and guidelines issued by the Swedish National Board of Health and Welfare. The template includes, in accordance with the board, what disaster preparedness should pay particular attention to in the planning process, in relation to the different components of disaster preparedness.</p><p>The results demonstrate that the template in combination with the risk assessment tool made it possible for an expert group to systematically conduct risk analysis within the identified areas of the disaster preparedness. Future development of this methodology will be needed in order to analyse and evaluate the effects of risk mitigation measures.</p>

Samhällets utveckling i kombination med förändringar inom hälso- och sjukvården ökar risken att drabbas av en allvarlig händelse. Hälso- och sjukvården måste därför anpassas för att kunna hantera situationer med ett stort skadeutfall, i samma utsträckning som en oväntad minskning av tillgänglig kapacitet, till exempel vårdplatsbrist. Genom att hitta svagheter i verksamheten så ökar möjligheterna att åtgärda dessa och därmed förmågan att kunna upprätthålla de ordinarie målen för vård och behandling av patienter vid en allvarlig händelse. Syftet med denna studie var att utveckla och testa en arbetsmetod för att systematiskt kunna analysera och utvärdera katastrofmedicinsk beredskap, samt identifiera, orsaksbestämma, åtgärdsanalysera och mäta förmågan att hantera de för Landstinget i Östergötland (LiÖ) väsentliga områdena av katastrofmedicinskt beredskap. För detta ändamål utvecklades en arbetsmetod genom att kombinera en av Katastrofmedicinskt Centrum skapad strukturmall med den metod som Patientsäkerhetsenheten inom LiÖ använder sig av vid riskanalyser. Strukturmallen utgår ifrån Socialstyrelsens föreskrifter och allmänna råd (2005:13) om vad Hälso- och sjukvården särskilt bör uppmärksamma i relation till vad dess verksamhet skall baseras på. Resultatet visar att strukturmallen i kombination med patientsäkerhetsmetoden ger möjlighet att systematiskt utföra riskanalyser inom de identifierade områdena av katastrofmedicinsk beredskap. Arbetsmetoden bidrog till en samsyn om olika begrepps betydelse, samt identifiering och värdering av för den katastrofmedicinska beredskapen förekommande risker. En fortsatt utveckling av metoden krävs för att kunna analysera och utvärdera effekter av riskminskande åtgärder. / The aim of the study was to develop and test a new methodology for a systematic analysis of disaster preparedness in the County Council of Östergötland. The aim was also to identify, categorise and create measurability of the surge capacity within important fields of the disaster preparedness of the County Council of Östergötland. The methodology is based on the use of a template developed by the Centre for Teaching and Research in Disaster Medicine and Traumatology (KMC), in combination with a validated patient risk assessment tool. The KMC template is based on national regulations and guidelines issued by the Swedish National Board of Health and Welfare. The template includes, in accordance with the board, what disaster preparedness should pay particular attention to in the planning process, in relation to the different components of disaster preparedness. The results demonstrate that the template in combination with the risk assessment tool made it possible for an expert group to systematically conduct risk analysis within the identified areas of the disaster preparedness. Future development of this methodology will be needed in order to analyse and evaluate the effects of risk mitigation measures.

For centuries, pandemic influenza has emerged at irregular and unpredictable intervals to cause widespread illness, hospitalization and death. Uncertainty surrounding the timing and severity of future influenza pandemics present challenges for preparedness and response efforts. The objective of this dissertation is to advance pandemic influenza knowledge and preparedness, through a series of interrelated articles that address the follow research questions: 1. What are the likely consequences of a pandemic flu event in Canada? 2. What do mathematical models tell us about preparing for such an event? 3. What is the best way to mitigate the consequences of an influenza pandemic? Six articles were prepared for submission in scientific, peer-reviewed journals. The first is a historical review of the burden of pandemic influenza. The second and third are systematic reviews of the effectiveness of interventions to interrupt pandemic influenza transmission. The fourth and fifth are research papers presenting a novel mathematical model, assessing the preparedness of the Canadian hospital system to accommodate expected surges in patient demand and evaluating intervention strategies to mitigate impact. The sixth is a policy-oriented paper discussing pandemic policy options within the context of public health ethics and risk management principles. Pandemic vaccination, antiviral treatment, voluntary isolation and personal protective measures were identified as the most cost-effective interventions available. Antiviral prophylaxis, community-contact reduction, school closure and quarantine were less effective, and tended to be associated with higher associated economic burdens. The timely implementation of layered intervention strategies appears likely to protect hospital-resource adequacy, though areas of Southwestern Ontario appear to be more vulnerable to surges in patient demand. However, the potential for high health and economic burdens, coupled with the uncertain severity of future pandemics, necessitates a flexibility in preparedness and response plans.

Background: The COVID-19 pandemic calls attention to the importance of sustainable healthcare systems. Frail healthcare systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Significant work has been done to describe the general attribute of sustainability and resilience in healthcare systems during crises. The next step would be to identify the research domains that has been highlighted during COVID-19 pandemic in order to reflect and achieve further sustainability in healthcare systems.  Methods: A scoping review of the literature was conducted to identify recurring themes, research domains and capacities needed to maintain healthcare systems’ sustainability in COVID-19 outbreak. Until 13 December 2020, six electronic databases were searched using specific keywords such as ‘sustainability,’ ‘resilience,’ and ‘surge capacity’ in ‘healthcare systems.’ Peer-reviewed articles went through a scientometric analysis mapping research fields, domains, study destinations and keywords.  Results: 104 studies met the inclusion criteria – majority (75%) focused on medical research followed by interdisciplinary (12%), social science (5%), and environment studies (5%). Originally identified domains of healthcare systems’ sustainability research included ‘capacity calculation,’ ‘telehealth,’ ‘environment,’ ‘inequity,’ ‘data,’ ‘holistic nexus planning,’ ‘social &amp; environmental risk factor,’ ‘transport connectivity,’ and ‘vulnerability.’  Conclusion: This scoping review represents a systematic assessment of the research domains of healthcare systems’ sustainability during COVID-19 pandemic. Further refined and broadened sustainability framework is required so that healthcare systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.

Den svenska intensivvården drabbades 2020 av en svår kris när coronapandemin mångdubblade antalet svårt sjuka patienter i en redan hårt belastad verksamhet. För att hantera krisen behövde sjukvården ställa om till katastrofsjukvård. Syftet med denna uppsats är att ge en fördjupad bild av intensivvårdens kapacitetsökningsförmåga, katastrofomställning och anpassning under Covid -19. Ett intervjuresultat togs fram genom semistrukturerade intervjuer och med hjälp av PAR-modellen härleddes förutsättningarna för den katastrofomställning som genomfördes. Arbetet är en av de första studierna som undersöker coronapandemins effekter på intensivvården med en tydlig riskvetenskaplig metodik. Intervjuresultatet tolkades med hjälp av en kontextanpassad och tillämpad PAR-modell ochvisade att trots en oförberedd sjukvård och dåliga grundförutsättningar lyckas den undersökta verksamheten absorbera chocken och genomföra en katastrofomställning. Den anpassade sig till den grad att patienterna kunde få en kvalitativ vård tack vare stora uppoffringar och umbäranden från vårdpersonalen. / The Swedish intensive care was hit by a severe crisis when the corona pandemic 2020 multiplied the number of seriously ill patients in an already strained health care system. In order to cope with the crisis the healthcare system needed to undergo a surge and adapt to disaster medicine operations. The purpose of this essay was to give an in-depth picture of intensive care's medical surge capacity, transition to disaster medicine and adaptation during Covid -19 through semi-structured interviews. Using the PAR-model I derived the conditions for the disaster transition that was carried out. The work is one of the first studies with a clear risk science methodology that examines the effects of the corona pandemic on the intensive care. The result from the interviews was interpreted with the PARmodel that was adapted to the studies context and showed that despite an underprepared healthcare system and poor basic conditions, the investigated operations manage to absorb the shock and implement a transition to disaster medicine and adapt to the extent that patients could receive qualitative care thanks to great sacrifices and hardship of the healthcare staff.