Every time emergency responders respond to an incident, they enter an ambiguous situation that is an ill-defined problem space. As the responders engage with the incident, they discover, piece by piece, the unique interlocking problems and act quickly to put form and structure onto the potential solution. In order to quickly, effectively, and safely resolve an incident, emergency responders must have depth and breadth of knowledge across responder disciplines and domains. This knowledge is acquired through both formal training courses and informal training in the station house. The ability to quickly assess a situation, accurately identify the elements as they emerge and their significance, then decide on a course of action combining a variety of domains and skill sets speaks to the creative nature of emergency responders. This study uses naturalistic inquiry to explore what it is like to be an emergency responder, describe how creativity manifests itself in a field environment, and discuss what emergency responders want in their training. This study found that being an emergency responder is emotional, exciting, stressful, challenging, full of the unexpected, and rewarding. During an incident, emergency responders are dealing with the complex interactions of various emotions while resolving difficult and often sad situations. Being an emergency responder is synonymous with being a good problem solver; they are also highly emotionally resilient. The process of creativity within an emergency response environment is seen through preparation that is, training. The consistent review and development of skills makes the skills automatic. Responders also cross-train and, often, an individual responder will have expertise in multiple areas. The improvisational skills of emergency responders to events which are often emergent and creative in their own right, demonstrate a depth of creative force through the handling of complex, high-risk situations with persistence, endurance, and determination. Finally, this study found that emergency responders are passionate about their training. They know that what they learn and practice during training evolutions forms the foundation of their professionalism, provides opportunities to learn new skills or hone already established skills, reinforces safety considerations, and will save their lives and the lives of other people.

With the outbreak of the 2009 pandemic influenza A (H1N1) comes the need to evaluate the preparedness level of government entities that had preparedness plans. This study looks at the preparedness level for pandemic influenza among key leaders in Brazos County according to their Brazos County Pandemic Influenza Preparedness Plan. Ten key leaders were recruited to participate in interviews. Interviews were transcribed and analyzed for salient themes. Main themes that emerged from interviews were categorized into vaccinations, communication, logistical issues, and the need for evaluations and feedback. Recommendations for increasing preparedness include addressing contingency plans, increasing education through public health efforts, addressing biosecurity, increasing use of technology, and increasing funding and research.

The public health emergencies, such as bioterrorist attacks or pandemic outbreaks, have gained serious public and government attentions since the 2001 anthrax attacks and the SARS outbreak in 2003. These events require large-scale and timely dispensing of critical medical countermeasures for protection of the general population. This thesis research focuses on developing mathematical models, real-time algorithms, and computerized decision support systems that enable (1) systematic coordination to tackle multifaceted nature of mass dispensing, (2) fast disease propagation module to allow immediate mitigation response to on-site uncertainties, and (3) user-friendly platform to facilitate modeling-solution integration and cross-domain collaboration. The work translates operations research methodologies into practical decision support tools for public health emergency professionals. Under the framework of modeling and optimizing the public health infrastructure for biological and pandemic emergency responses, the task first determines adequate number of point-of-dispensing sites (POD), by placing them strategically for best possible population coverage. Individual POD layout design and associated staffing can thus be optimized to maximize throughput and/or minimize resource requirement for an input throughput. Mass dispensing creates a large influx of individuals to dispensing facilities, thus raising the risk of high degree of intra-facility infections. Our work characterizes the interaction between POD operations and disease propagation. Specifically, fast genetic algorithm-based heuristics were developed for solving the integer-programming-based facility location instances. The approach has been applied to the metro-Atlanta area with a population of 5.2 million people spreading over 11 districts. Among the 2,904 instances, the state-of-the-art specialized integer programming solver solved all except one instance to optimality within 300,000 CPU seconds and solved all except 5 to optimality within 40,000 CPU seconds. Our fast heuristic algorithm returns good feasible solutions that are within 8 percent to optimality in 15 minutes. This algorithm was embedded within an interactive web-based decision support system, RealOpt-Regional©. The system allows public health users to contour the region of interest and determine the network of PODs for their affected population. Along with the fast optimization engine, the system features geographical, demographical, and spatial visualization that facilitate real-time usage. The client-server architecture facilities front-end user interactive design on Google Maps© while the facility location mathematical instances are generated and solved in the back-end server. In the analysis of disease propagation and mitigation strategies, we first extended the 6-stage ordinary differential equation-based (ODE) compartmental model to accommodate POD operations. This allows us to characterize the intra-facility infections of highly contagious diseases during local outbreak when large dispensing is in process. The disease propagation module was then implemented into the CDC-RealOpt-POD© discrete-event-simulation-optimization. CDC-RealOpt-POD is a widely used emergency response decision support system that includes simulation-optimization for determining optimal staffing and operations. We employed the CDC-RealOpt-POD environment to analyze the interactions between POD operations and disease parameters and identified effective mitigation strategies. The disease propagation module allows us to analyze the efficient frontier between operational efficiencies and intra-POD infections. Emergency response POD planners and epidemiologists can collaborate under the familiar CDC-RealOpt-POD environment, e.g., design the most efficient plan by designing and analyzing both POD operations and disease compartmental model in a unified platform. Corresponding problem instances are formed automatically by combining and transforming graphical inputs and numerical parameters from users. To facilitate the operations of receiving, staging and storage (RSS) of medical countermeasures, we expanded the CDC-RealOpt-POD layout design functions by integrating it with the process flow. The resulting RSS system allows modeling of both system processes along with spatial constraints for optimal operations and process design. In addition, agent-based simulation was incorporated inside where integrated process flow and layout design allow analysis of crowd movement and congestion. We developed the hybrid agent behavior where individual agents make decision through system-defined process flow and autonomous discretion. The system was applied successfully to determine guest movement strategies for the new Georgia Aquarium Dolphin Tales exhibit. The goal was to enhance guest experience while mitigating overall congestion.

This thesis presents the design and evaluation of the location of a cell phone user, to enable more effective performance monitoring. One of the end-uses I propose is in emergency management, by means of a framework that distributes its functionality between establishing data-set characteristics that are relevant to the problem and a visual tool to evaluate resource-scheduling proposals. Manikarnika is a modular framework, which finds translation in a prototype for Reverse 111. The first steps in the process were to establish whether the parameters I hypothesized as useful, indeed were. Using a statistically significant amount of traces, obtained from real calls placed on the network, the utility of the location metric was established. In order to investigate utilizing a second metric of reputation, a benchmark for evaluating ideas from Social Networks research was proposed, in order to move from arbitrary testing to a more systematic environment. This dissertation details the measurement, design and evaluation of an end-to-end and modular framework for Emergency Management, where the functionality is distributed in order to easily incorporate the changing parameters of sources of information, emergency events, resource requirements of these events and identifying callers that might be able to provide better insight into a situation that is essentially very dynamic. The chasm between research proposals for various end-uses and the application of the same to real life is one that I have tried to bridge in my work. By incorporating pieces from core Electrical Engineering measurements and simulation and extending the use of what was originally a tool built for training Emergency Responders to analyze various resource scheduling agents, which take into account a diversity of administrative domains, I lay the ground work for one possible solution, Reverse 111, which proposes the use of proactive crowd-sourcing for emergency response, with easy extensions to commercial location-based applications.

Recent international and national events such as the SARS outbreak in 2002–2003, the rising incidence of West Nile Virus, and the increasing threat of a pandemic influenza outbreak have brought critical attention to the Canadian public health system and how prepared the system is to respond to various types of contemporary public health threats. The effective coordination of all agencies at metropolitan, regional, provincial, and federal levels is essential to the management of public health emergencies. The level of inter-organizational coordination and preparedness of public health and emergency preparedness organizations throughout Alberta was investigated. An online organizational questionnaire provided a census of organizations involved in public health preparedness, and information on the structure of inter-organizational relations in Alberta and the state of public health preparedness from the perspective of organizational members. The primary goal was to use the information provided by individual agencies to help improve how policymakers and public health and emergency management officials plan and organize for public health threats and emergencies. Major findings are as follows: i) organizational characteristics including organizational training opportunities, size, and jurisdiction are associated with different dimensions of organizational-level preparedness in Alberta, ii) perceived organizational connectivity serves as a proxy measure of formal ties objectively reported by organizations with respect to pandemic influenza preparedness, iii) higher jurisdictional organizations display greater degrees of interconnectedness on average, and iv) organizational connectivity moderates the association of perceived public health preparedness with an organization’s objective level of preparedness, independent of jurisdictional level. The true test of public health preparedness is in how the system responds to an actual crisis. Since public health emergencies are rare, there is an absence of province-wide data in this regard; however, this work has measured organizational-level perceptions of public health preparedness as a proxy for actual preparedness. It is critical that organizations have a written emergency response plan which is tested in practice through exercises or in a real situation to observe jurisdictional and organizational ability to execute an appropriate response and assess communication and resource flow among organizations. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2009-04-17 15:58:33.093

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Master of Science / Department of Chemical Engineering / Larry E. Erickson / As our society continues to better prepare itself to address biological, radiological, chemical, and environmental emergencies, there is a need for better and more readily available emergency planning information for program managers and military/business personnel. An online hazardous materials and emergency planning tool for the Environmental Knowledge and Assessment Tool (EKAT: www.ekat-tool.com) would adequately fill that need. The proposed online Emergency Preparation and Green Engineering (EPGE) tool would provide the user with information regarding links to local emergency response teams and resources, guides for developing emergency plans and reports, Hazardous Materials (HAZMAT) training information, case studies to illustrate HAZMAT situations, and the ability to judge the environmental friendliness of chemicals. In this way it will serve as a means of facilitating and educating individuals for best responses in an organized fashion. In order to address their environmental responsibilities, public and private organizations are adopting Environmental Management Systems (EMS). The EPGE tool can be used in conjunction with Environmental Management Systems (EMS) to begin to address sustainability in a more practical setting. Currently the development of a comprehensive tool that identifies environmental, health, and safety concerns along with supplying relevant emergency data would be applicable to any business or organization. This tool will be available as an initial building block for the sustainability of the company. It can be used as a guide to better characterize and solve the environmental issues that could affect any business.

Timely activation of the rapid response team (RRT) depends on the nurse's willingness and ability to make a rapid decision. The practice-focused questions for this DNP project sought to identify barriers that contribute to delays in activating the RRT when needed in medical-surgical patients. The self-efficacy theory was the guiding theory and was used to examine self-confidence and performance along with Donabedian's health care model. Qualitative data were obtained through focus groups and identified 2 prominent thematic barriers among nurses with less than 3 years' experience: a lack of self-confidence and the of lack of knowledge and experience. Results of a chart review included 34 charts to determine if the RRT were called appropriately and were inconclusive. Finally, an 11 item survey with 9 demographic questions showed a statistically significant difference on the summed survey score between nurses with less than 3 years of experience and more tenured nurses, indicating a lack of perceived support, self-confidence, and knowledge among the nurses with less than 3 years of experience (Pearson chi square = 7.403 with 2 df and p = .025). Results were presented to leaders at the site and the recommendations resulting from these observations include the use of high-fidelity simulation education. Nurse educators and senior leadership from the medical surgical units agreed to accept the recommendations and proceed with developing an educational solution to address the barriers. Building knowledge, skills and self-confidence in nurses reduces the barriers to effective use of the RRT, and results in better outcomes for hospitalized medical-surgical patients, a positive social change.

Incidents affecting the livestock industry are unavoidable in today's society. These incidents can happen at livestock shows across the country putting thousands of exhibitors, visitors, employees and livestock in danger. The purpose of this study was to determine local officials' perceptions and awareness of incident planning and response pertaining to selected livestock shows. Little research has been completed in this area; therefore, this foundational study was needed. The objectives of this study were to determine local officials' awareness of livestock shows and incident response plans for those livestock shows. In addition, the researcher wanted to describe the roles of local officials in incident planning and response at livestock shows. Level of communication and perceptions of challenges at livestock shows and among local officials were also evaluated. Lastly, the researcher wanted to describe local officials' recommendations for effective incident planning and response related to livestock shows. Five participants remarked on the value of this study and agreed to participate. These participants included livestock show officials involved in incident planning and response or local emergency management officials. Each participant was interviewed, and then data were transcribed and categorized to consensus. Nine themes arose including: background information, challenges, communication, example incidents, executing incident response, incident response planning, incident response training, miscellaneous and need for planning. It was concluded that all participants were aware of the selected livestock shows. However, levels of awareness varied by participant due to work-related experiences with the livestock show. The two livestock show participants were aware of specific incident response plans for the livestock show, while the three local emergency management officials were aware of city emergency management plans. Each participant remarked upon their roles in planning and executing incident response. In addition, communication was thought to be one of the key factors to successful incident planning and response. Challenges ranging from lack of communication to training for incident response were stated. Lastly, participants remarked on recommendations for others planning for incident response at livestock shows. These recommendations included communication, preplanning, building relationship with key stakeholders, training, and a need for more planning and research in this area. It is recommended that this study be replicated with scaled objectives for measuring awareness of livestock shows and incident response plans. Also, replicate this study to determine level of training in incident response and safe handling of livestock. It is recommended to describe communication between livestock shows and local emergency management officials. Lastly, it is recommended to replicate this study with regional livestock shows and state fairs.

Training emergency response decision makers using live, virtual and/or constructive simulations can be highly complex since certain situations can generate stimulusresponse cycles that depend significantly on unpredictable human judgments. In particular, effective training scenarios require a combination of content contributed via pre-authored scripts and content generated dynamically during the training exercise. Large-scale exercises require multiple domain experts contributing oversight and content to the scenario as it proceeds. Such real-time adaptation requires situational and group awareness based on an understanding of pre-scripted materials and the adaptations of others. This thesis describes the evolution and evaluation of a collaborative graphical timeline system, called the Scenario Timeline System (STS), which facilitates asynchronous and synchronous collaborative timeline management, and its application in large-scale, computer-supported emergency response training exercises.