The importance of critical thinking skills in disaster management.

The adverse circumstances occasioned by disasters rarely remain static but rather continue to evolve, temporally and spatially, rendering preplanned response operations uncertain, at best, and ineffectual, at worst. As such, disaster management professionals need to think critically to implement response strategies best suited to the circumstances at hand, with the best available information. This paper provides an overview of critical thinking, and its importance in helping leaders provide order to the chaos often associated with disaster response and recovery efforts.

Enhancing resiliency for elderly populations : Shelter-in-place planning and training at facilities serving elderly populations through the Rhode Island Senior Resiliency Project.

Elderly populations are disproportionately affected by disasters. In part, this is true because for many older adults, special assistance is needed to mitigate the consequences of disasters on their health and wellbeing. In addition, many older adults may reside in diverse living complexes such as long-term care facilities, assisted living facilities and independent-living senior housing complexes.

Inter-organisational response to disasters.

Inter-organisational communication failures during times of real-world disasters impede the collaborative response of agencies responsible for ensuring the public's health and safety. In the best of circumstances, communications across jurisdictional boundaries are ineffective. In times of crisis, when communities are grappling with the impact of a disaster, communications become critically important and more complex.

Clinical guidelines for responding to chemical, biological, radiological, nuclear and trauma/burn mass casualty incidents: Quick reference guides for emergency department staff.

The word 'DISASTER' may be used as a mnemonic for listing the critical elements of emergency response. The National Disaster Life Support Education Foundation's (NDLSEC) DISASTER paradigm emphasises out-of-hospital emergency response and includes the following elements: (1) detect; (2) incident command system; (3) security and safety; (4) assessment; (5) support; (6) triage and treatment; (7) evacuate; and (8) recovery. This paper describes how the DISASTER paradigm was used to create a series of clinical guidelines to assist the preparedness effort of hospitals for mitigating chemical, biological, radiological, nuclear incidents or explosive devices resulting in trauma/burn mass casualty incidents (MCIs) and their initial response to these events.

Integrating public health and medical intelligence gathering into homeland security fusion centres.

Homeland security fusion centres serve to gather, analyse and share threat-related information among all levels of governments and law enforcement agencies. In order to function effectively, fusion centres must employ people with the necessary competencies to understand the nature of the threat facing a community, discriminate between important information and irrelevant or merely interesting facts and apply domain knowledge to interpret the results to obviate or reduce the existing danger. Public health and medical sector personnel routinely gather, analyse and relay health-related inform-ation, including health security risks, associated with the detection of suspicious biological or chemical agents within a community to law enforcement agencies.

Disaster and exercise performance information collection tool: capturing observations in four minutes or less.

The objectives of the work described in this paper were to: (a) identify existing gaps in data collection, processing and dissemination across all types of emergencies; (b) build a tool that permits documentation, manipulation and propagation of relevant observations in emergency preparedness exercises or real-world incidents to inform critical decision makers in real time and to facilitate the elaboration of lessons learned, best practices and pioneering strategies for the management of future disasters; (c) validate the efficacy of the tool for collecting, processing and disseminating disaster-related information, through its integration in a series of exercises. The disaster and exercise performance information collection tool (DEPICT) was developed to address needs identified via the analysis of survey responses provided by representatives of military and civilian organisations with disaster response experience. Consensus discussions were held to identify criteria and operational parameters for the tool.

Resource allocation: an approach for enhancing hospital resiliency.

The objective of the work described in this paper was to develop the Hospital Emergency Support Function (HESF) model, which could be used by hospitals to augment medical surge capacity based on the reallocation of internal hospital personnel, in the wake of a catastrophic natural or manmade disaster. A group of subject matter experts, including clinicians with disaster response experience, hospital emergency coordinators and business continuity planners, was assembled to conceptualise the basic framework of the HESF model. The model was validated via feedback from a panel of decision makers at Yale-New Haven Hospital and development of a consensus among the panel, using a modified Delphi method.

Collective response to public health emergencies and large-scale disasters: putting hospitals at the core of community resilience.

Healthcare organisations are a critical part of a community's resilience and play a prominent role as the backbone of medical response to natural and manmade disasters. The importance of healthcare organisations, in particular hospitals, to remain operational extends beyond the necessity to sustain uninterrupted medical services for the community, in the aftermath of a large-scale disaster. Hospitals are viewed as safe havens where affected individuals go for shelter, food, water and psychosocial assistance, as well as to obtain information about missing family members or learn of impending dangers related to the incident.

Fostering disaster resilient communities across the globe through the incorporation of safe and resilient hospitals for community-integrated disaster responses.

The impact of catastrophic events on hospitals and communities is huge and continues to hinder progress in developing nations and industrialized countries alike. Over the last 10 years, the UN/ISDR has sponsored a series of global conferences to increase awareness of the importance of risk and vulnerability reduction and the need to build disaster resilient communities. In recognition that hospitals contribute to the health and resiliency of a community, ISDR has adopted the PAHO and WHO "Safe and Resilient Hospital" initiative.

Recommended modifications and applications of the Hospital Emergency Incident Command System for hospital emergency management.

The Hospital Emergency Incident Command System (HEICS), now in its third edition, has emerged as a popular incident command system model for hospital emergency response in the United States and other countries. Since the inception of the HEICS in 1991, several events have transformed the requirements of hospital emergency management, including the 1995 Tokyo Subway sarin attack, the 2001 US anthrax letter attacks, and the 2003 Severe Acute Respiratory Syndrome (SARS) outbreaks in eastern Asia and Toronto, Canada. Several modifications of the HEICS are suggested to match the needs of hospital emergency management today, including: (1) an Incident Consultant in the Administrative Section of the HEICS to provide expert advice directly to the Incident Commander in chemical, biological, radiological, nuclear (CBRN) emergencies as needed, as well as consultation on mental health needs; (2) new unit leaders in the Operations Section to coordinate the management of contaminated or infectious patients in CBRN emergencies; (3) new unit leaders in the Operations Section to coordinate mental health support for patients, guests, healthcare workers, volunteers, and dependents in terrorism-related emergencies or events that produce significant mental health needs; (4) a new Decedent/Expectant Unit Leader in the Operations Section to coordinate the management of both types of patients together; and (5) a new Information Technology Unit Leader in the Logistics Section to coordinate the management of information technology and systems.