This document provides an overview of resources for disaster health information. It describes a training session that covers locating peer-reviewed literature, grey literature, surveillance data and tools from organizations like NLM, CDC and WHO. The document discusses classifying disaster-related topics in subject headings and evaluating sources. It also demonstrates NLM's WISER, REMM and CHEMM applications for hazardous materials, radiation and chemical incidents. Finally, it explores using social media, apps and alerts to stay updated on disaster health issues.
4. Timeline created using dipity: http://www.dipity.com/ H1N1 Web Activity: March – June, 2009
5. Objectives By the end of the course, you will: 1.Be comfortable locating disaster health information 2.Be confident using a variety of disaster health databases, tools and websites 3.Be knowledgeable about initiatives and technologies for accessing disaster health information
6. Agenda Intro - DisasterMedicine & DisasterWorkforce Case Discussion Disaster Literature Search Exercises BREAK NLM Resources for Disaster Health Information Search Exercises BREAK Tools – Apps, Email Lists, RSS, Widgets Summary Practice Exercises
7. What is a Health Disaster? A precipitous or gradual decline in overall health status of a community for which the community is unable to cope without outside assistance. WADEM, 2003
8. Related Terms Disaster: a serious disruption of the functioning of society, causing widespread human, material or environmental losses which exceed the ability of affected society to cope using only its own resources. Emergency: a situation that is out of control and requires immediate attention. Event: an occurrence that has the potential to affect living beings and/or their environment; a realization of a hazard. http://www.wadem.org/guidelines/glossary.pdf IDNDR, 1992 WADEM, 2003
10. Disaster Workforce Licensed or trained Paid or volunteer Permanent or as-needed workers … who play a defined role in… All-hazards preparedness, response and recovery In implementing Emergency Support Functions 6 & 8: Mass care, Emergency Assistance, Disaster Housing & Human Services; Public Health and Medical Services
13. Case Discussion: Pandemic At the end of April, 2009, an administrator from a hospital critical incident planning team asks you to find information to answer the question: What is the effectiveness of antiviral agents for H1N1? What are some specific challenges related to finding information in this case? How would you approach this question?
31. Exercise: Information for Professionals A child psychiatrist asks you to find articles to answer the question: What is the post-hurricane pattern of behavioral and emotional problems in children? HazLit: http://ibs.colorado.edu/hazards/library/hazlit/NatHazSearch.php PubMed: http://www.ncbi.nlm.nih.gov/pubmed NCBI Bookshelf: http://www.ncbi.nlm.nih.gov/books
32. Exercise: Information for Professionals Find documents outlining procedures for preparing hospitals for an earthquake 1. DIMRC (Disaster Information Management Research Center) - Resource Guide for Public Health Preparedness: http://phpreparedness.nlm.nih.gov 2. PAHO (Pan American Health Organization) – Area on Emergency Preparedness and Disaster Relief: http://new.paho.org/disasters/ 3. PubMed: http://www.ncbi.nlm.nih.gov/pubmed
33. Other Sources of Professional Information - Federal AHRQ’s (Agency for Healthcare Research & Quality) Archive – Public Health Emergency Preparedness: http://archive.ahrq.gov/prep/ ASPR’s (Office of the Assistant Secretary for Preparedness and Response) Public Health Emergency: http://www.phe.gov/ CDC’s Emergency Preparedness and Response – Pages for Professionals: http://emergency.cdc.gov/
36. Exercise: Disaster Health Information for the Public Use the following resources to find information on health hazards after a flood for a consumer audience. 1. CDC 2. DIMRC 3. FEMA 4. MedlinePlus 5. PHE.gov
37. Surveillance Exercise Find recent incidence figures for Influenza 1. CDC – MMWR State Health Statistics: http://www.cdc.gov 2. ECDC – Surveillance: http://ecdc.europa.eu 3. WHO – Global Alert and Response: http://www.who.int/en
38. Exercise A hospital’s critical incident planning team is developing an all hazards preparedness training program on medical surge. Find best quality evidence to assist their planning.
45. NLM’s Disaster Information Tools & Mobile Applications: WISER HazMat/CBRN Information -~420 Chemical Agents -~20 Radiological Agents -CDC Category A Biological Agents Includes -Substance characteristics/properties -Department of Transportation (DOT) Emergency Response Guidebook (ERG) data: Fire-fighting procedures, safe protective distance, etc. -Human health/medical treatment data Features/Capabilities -Chemical identification support – via chemical properties, signs/symptoms, transportation, etc. -Safe protective distance mapping - GIS -Chemical reactivity feature
47. WISER Exercise* 1. Search WISER http://wiser.nlm.nih.gov/to answer the question: What type of personal protective equipment (PPE) & protective distance is required for a large spill of xylenes?
48.
49. For health care workers diagnosing and treating patients during radiological/nuclear events
59. Includes identification tools and medical management guidelines for chemical groups and syndromeshttp://chemm.nlm.nih.gov/
60. CHEMM Exercise: http://chemm.nlm.nih.gov/ 1. Search CHEMM to answer the question: Identify the syndrome for an unconscious patient who has been exposed to an unknown chemical and presents with pinpoint pupils, arrhythmia and is sweaty? 2. What is the recommended treatment for this patient in the emergency department?
62. Exercises Use NLM’s resources to answer the following questions: 1. What are guidelines for setting up a chemical decontamination area outside a hospital emergency department? 2. What disaster triage category should be assigned to a patient who cannot walk, exhibits spontaneous breathing and a respiratory rate greater than 30?
64. Role of Social Media “Clearly, social media are changing the way people communicate not only in their day-to-day lives, but also during disasters that threaten public health.” (Merchant, 2011)
70. Stay Informed - RSS CDC: http://www2c.cdc.gov/podcasts/rss.asp Contains dozens of RSS feeds on disaster topics Includes the MMWR ECDC: http://ecdc.europa.eu/en/Pages/rssfeeds.aspx Includes epidemiological updates, influenza surveillance data and other public health news FEMA:http://www.fema.gov/help/rss.shtm Contains disaster declarations by state, mitigation best practices, information on disaster recovery centers, and more NLM: http://sis.nlm.nih.gov/sisrssfeed.html Includes updates from NLM’s division of Specialized Information Services, which includes DIMRC WHO: http://www.who.int/about/licensing/rss/en/ Contains Disease Outbreak, and Emergencies and Disasters news feeds
86. Stay Informed - Widgets CDC Widgets - http://www.cdc.gov/widgets/ DIRLINE for state disaster organizations - http://disasterinfo.nlm.nih.gov/dimrc/widgetdimrc.html#dirline FEMA Widgets - http://www.fema.gov/help/widgets/
87. Summary 1. NLM’s ________ gives free access to literature to areas affected by disasters. 2. Some topics under the subject “Disaster Medicine” include _________, _________, __________. 3. Use ________ to find peer-reviewed journal articles and books on disaster health topics. 4. _________ includes diagnostic information for chemical exposure? 5. First responders use ________ to identify unknown toxic agents. 6. _________ are examples of a surveillance tools.
88. Key Points 1. An influx of information and research interest will commonly occur shortly after a major disaster. Be prepared to answer questions and consider using tools like RSS and email lists to monitor information as it is being produced.
89. Key Points 2. The “disaster workforce” is very large and contains both licensed professionals and volunteers. Consider using sources for both a professional and public/consumer audience when proving disaster health information.
90. Key Points 3. There are more “Grey Literature” sources of disaster health information than peer-reviewed, indexed sources. Use a combination of bibliographic databases, federal websites and aggregators, surveillance tools, professional associations, and academic centers to locate disaster health literature.
91. Key Points 4. NLM’s tools contain specialized information for first responders and receivers. Consider the nature of the disaster/emergency when recommending a tool. WISER for Haz/Mat, CBRNE REMM for radiological CHEMM for chemical
92. Key Points 5. Social software is revolutionizing the method of delivering disaster health information. Use apps, email lists, RSS, Twitter & widgets to stay informed.
93. Practice Exercises Answer the question: What are recommendations regarding hospital oxygen supplies for an influenza pandemic? Find recent incidence figures for cholera Find consumer information on the health effects of wild fires Answer the question: How do you diagnose for wound contamination from radioactive shrapnel? Find best evidence on facemask use by children during respiratory infectious disease outbreaks
94. References & Further Reading Barbisch, D., Haik, J., Tessone, A., & Hanfling, D. (2010). Surge Capacity. In Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practice. New York: Cambridge University Press. 33-49. CDC. (2011). Preparedness for All Hazards. Accessed August 13, 2011 from: http://www.bt.cdc.gov/hazards-all.asp DMORT (Disaster Mortuary Operational Response Teams). (2011). Who Makes Up a DMORT Team? Accessed August 13, 2011 from: http://www.dmort.org/DNPages/DMORTPeople.htm ESAR-VHP (The Emergency System for Advance Registration of Volunteer Health Professionals). (2011). Who is Eligble? Accessed August 13, 2011 from: http://www.phe.gov/esarvhp/pages/registration.aspx FEMA. (2008). Emergency Support Function Annexes: Introduction. Accessed August 6, 2011 from: http://www.fema.gov/pdf/emergency/nrf/nrf-esf-intro.pdf IDNDR (International Decade of Natural Disaster Reduction). 1992. Internationally agreed glossary of basic terms. Kaji, A., Koenig, K., Bey, T. (2006). Surge capacity for healthcare systems: a conceptual framework. Acad Emerg Med. 13(11). 1157-1159. Koenig, K.L., & Schultz, C.H, (Eds.). (2010). Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practice. New York: Cambridge University Press. Merchant, R.M., Elmer, S. & Lurie, N. (2011). Integrating Social Media into Emergency-Preparedness Efforts. NEJM. 365(4). 289-291. WADEM (World Association for Disaster and Emergency Medicine). (2003). Glossary of Terminology. In Health Disaster Management: Guidelines for Evaluation and Research. Vol. 1. Madison: Prehospital and Disaster Medicine. Accessed September 8, 2011 from http://www.wadem.org/guidelines/glossary.pdf Yong, E. (2011). Disease Trackers. BMJ. 343(7814). 70-71.
95. Photo Credits* Flu.gov Widgets Embedded on Public Website by FluPortal.org and the National Center for Media Engagement: http://www.fluportal.org/quick/ F5 tornado Elie Manitoba 2007 by Justin1569 at en.wikipedia: http://commons.wikimedia.org/wiki/File:F5_tornado_Elie_Manitoba_2007.jpg GDE Bridge Collapse by Richard, Enzyme05’s photostream: http://commons.wikimedia.org/wiki/File:GDE_Bridge_Collapse.jpg Radiologist in San Diege CA 2010 by Zackstarr: http://commons.wikimedia.org/wiki/File:Radiologist_in_San_Diego_CA_2010.jpg Tamiflu NOR by KEN: http://commons.wikimedia.org/wiki/File:Tamiflu_NOR.JPG * Public domain image files downloaded from Wikimedia Commons. Attribution given as indicated by creators where applicable.
Graph description: number of confirmed and probable cases of swine-origin influenza A (H1N1) virus (S-OIV) infection, by date of illness onset, in Mexico, during March 15 to April 26, 2009.
Following a disaster, an explosion of available online information occurs. One of the challenges of searching for disaster information is having to navigate an influx of information and select best quality evidence to meet the information needs of the disaster workforce during the “Response” phase of a disaster. But disaster information needs don’t only occur during the response, but also during the mitigation, planning and recovery phases. In this course, we’ll describe information sources to meet the needs of all of these phases.
“All Hazards Preparedness” - Emergency preparedness requires attention not just to specific types of hazards but also to steps that increase preparedness for any type of hazard. (CDC, 2011)
Disaster Workforce as “target audience” for disaster health information.   Emergency Support Functions 6 & 8 – See: http://www.fema.gov/pdf/emergency/nrf/nrf-esf-intro.pdf
Photo 1 - Nurses: Advanced practice nurses (nurse practitioners, nurse anesthetists, certified nurse midwives, clinical nurses specialists) ; Licensed practical nurses and licensed vocational nurses ; Registered nursesPhoto 2 – Behavioral Health Professionals: Marriage and family therapists ; Medical and public health social workers ; Mental health and substance abuse social workers ; Psychologists ; Mental health counselorsPhoto 3 – EMTs: Emergency medical technicians (EMTs) and paramedicsPhoto 4 – VeterinariansPhoto 5 – DentistsPhoto 6 – PharmacistsPhoto 7 – Physicians: Physicians ; Physician assistants ; Emergency physicians and other “first receivers” Photo 8 – Radiologists: Radiologic technologists and techniciansOther: Cardiovascular technologist and technicians ; Medical and clinical laboratory technologists and technicians ; Respiratory therapistsSource: Who is Eligible? Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP). http://www.phe.gov/esarvhp/pages/registration.aspxÂ
Photo 1 – Trained community volunteers: Red Cross, Community Emergency Response TeamsPhoto 2 – Firefighters: Firefighters, including hazardous materials respondersPhoto 3 – Emergency Managers: Hospital and other health center administrators ; Public Information Officers (as defined in Incident Command System)Photo 4 – Military and civilian humanitarian assistance workersPhoto 5 – Librarians: Librarians, library staff, informationists, information specialistsPhoto 6 – Support Staff: Administrative and support staff for Medical Reserve Corps (MRC), Disaster Medical Assistance Teams (DMAT), and Disaster Mortuary Teams (DMORT) ; Social work assistants ; Laboratory support staff, administratorsPhoto 7 – ClergyPhoto 8 – Disaster Mortuary Team Members: Medical Examiner/Coroners, Forensic Pathologists, Forensic Anthropologists, Fingerprint Specialists, Forensic Odontologists, Funeral Directors/Embalmers, Dental Assistants, X-ray Technicians, Mental Health Specialists, DNA Specialists, Medical Records Technicians, Evidence Specialists (DMORT, 2011)Other: Health educators, Toxicologists, Environmental Health Workforce, Epidemiologists, Public Health Workers, Health profession and allied health students,
Note: this is only a list of the disaster medicine focused journals indexed in PubMed. There are Emergency Medicine journals with significant content on disaster health as well. And peer-reviewed disaster literature appears across many disciplines, in many journals.
Not all journal literature is publicly available at no cost. Many publishers require an individual or institutional subscription to access content. An opportunity to access disaster literature during the recovery period following a disaster event is NLM’s Emergency Access Initiative.Handbooks and guidebooks – very important references during the response phase (ex. Drug handbooks – many physicians practicing outside of their specialty areas). See NN/LM Toolkit for a “one shelf” reference library.
(1.) HazLit: The HazLit database part of the Natural Hazards Center Library at the University of Colorado, Boulder. HazLit contains citations to journal articles, books, and reports, in bound and electronic form. The Hazards Center Library does not provide a document delivery service and the center does not loan its holdings to the general public. Please contact your local library to determine how to obtain publications identified in the HazLit database: http://ibs.colorado.edu/hazards/library/hazlit/(2.) PubMed – The National Library of Medicine’s database of published biomedical literature. Full text articles may only be available to subscribers. Search PubMedCentral to find all full-text articles.(3.) NCBI Bookshelf - A collection of freely available, downloadable, on-line versions of selected biomedical books.
(1.) DIMRC (Disaster Information Management Research Center) – Resource Guide for Public Health: gateway to grey literature resources that are freely available on the web.(2.) PAHO (Pan American Health Organization) – Area on Emergency Preparedness and Disaster Relief - PAHO generates and disseminates knowledge about all aspects of disaster preparedness, risk reduction and management by: Producing and distributing technical guidelines and publications on public health and disastersMaking up-to-date information available for decision making through the Emergency Operations Center and multiple web pagesIdentifying, collecting and disseminating lessons learned and evidence-based informationDeveloping information tools, services and centers, such as the Regional Disaster Information Center—CRIDCreating information networks and promoting the use of new ways to communicate, learn and share information among key actors. (3.) PubMed – The National Library of Medicine’s database of published biomedical literature. Full text articles may only be available to subscribers. Search PubMedCentral to find all full-text articles.
(1.) ASPR, which will talk about in a moment, is the new office that was created in the past few years and was given the responsibility to act as the Dept. of Health and Human Services arm to lead the preparation and response to public health emergencies. Previously many of the information pages concerning public health emergencies was housed on AHRQ’s website. They have archived that material and there are still many relevant planning and guidelines documents accessible through this source. (2.) ASPR’s Public Health Emergency website (phe.gov): Contains content mostly drawn from the CDC. It is more of an aggregator site (like DIMRC), but is intended to be a first stop for news about large-scale disasters. (3.) CDC’s Emergency Preparedness and Response: Many summary pages include information for both the general public and for professionals. The section on “Mass Casualties,” for example, has information on medical response to large-scale events. Pages on “surge capacity” and “blast injuries,” include fact sheets and treatment protocols.
(1.) The American College of Emergency Physicians has a page on Emergency Medical Services and Disaster Preparedness. The content changes based on current events, but it has information about how emergency physicians can volunteer and fact sheets that present relevant medical information in a quick format. One document linked here that is worth a look is “Unsolicited Medical Personnel Volunteering at Disaster Scenes,” which is a policy paper that basically directs medical professionals to only respond when asked by local incident management.(2.) The American Medical Association has a Center for Public Health Preparedness and Disaster Response. On this page you can find information related to the latest emergencies and disasters, mostly links to resources we’ve already discussed. They publish the journal, Disaster Medicine and Public Health Preparedness, and sometimes offer webinars for CME credit that may be of interest to members of the disaster workforce.(3.) The American Red Cross is certainly a familiar organization, but worth a reminder here because of their leading role in responding to emergencies here in the US.(4.) The World Association for Disaster and Emergency Medicine (WADEM) is an interdisciplinary NGO that includes doctors, nurses, emergency planners, dentists, first responders, and many other members of the disaster workforce. WADEM publishes the journal Prehospital and Disaster Medicine and a textbook called International Disaster Nursing. On their site, you can read another book online, called Health Disaster Management: Guidelines for Evaluation and Research, which aims to offer a common framework to do research in this area.
In Addition to the Natural Hazards Center, at the University of Colorado at Boulder, which produces HazLit, there are other academic centers that are potential sources of disaster health information for a professional audience. (1.) In contrast to the Natural Hazards Center which narrows its focus on non-manmade events, the Center for Biosecurity looks at biological weapons attacks and large-scale epidemics. Their site presents a lot of articles on threat assessment and mitigation, but one area that may be especially handy is under BioAgents, where there are fact sheets on agents that have been identified as particular threats. The fact sheets have background information and citations for you to go into deeper information about them. (2.) The Center for Infectious Disease Research and Policy is based at the University of Minnesota and focuses on response to emerging infectious diseases and preparedness, especially pandemic flu. One interesting aspect of their work is that they look at business preparedness, in short, how to keep the nation operating if there is a pandemic flu. For example, they have news articles about efforts to require employers to offer sick leave so that workers do not report for duty while they have the flu(3.) The Center for the Study of Traumatic Stress is part of the Uniformed Services University. On their website, look under Resources for a collection of PDF fact sheets having to do with the psychological consequences of situations, including disasters. Some of the resources are available in Creole and Chinese. This would be a very good resource for answering the question about children’s psychology following a hurricane.(4.) The Institute of Medicine is part of National Academies, a private nonprofit. So far they’ve offered 14 live workshops in different parts of the country about different aspects of public health preparedness.
The CDC website contains information on specific disaster events for a consumer audience. The slant of their information is towards health effects and containing infectious agents. Floods page: http://emergency.cdc.gov/disasters/floods/DIMRC is a portal to information sources for multiple audiences – a good place to being your search. DIMRC is an aggregator resource (not a content resource). Floods page: http://sis.nlm.nih.gov/dimrc/floods.htmlFEMA also contains information on specific disaster events for a consumer audience. The scope of their information is more broad and will include non-health related topics, like insurance and other financial considerations for disaster victims. Floods page: http://www.fema.gov/hazard/flood/MedlinePlus is specifically designed for a consumer audience. It contains some overview information and also links to other sites: http://www.nlm.nih.gov/medlineplus/floods.htmlPHE.gov – Public Health Emergency website from ASPR (Office of the Assistant Secretary for Preparedness and Response). A portal page to government information on preparedness and response to public health emergencies (a lot of it is drawn from the CDC). Intended to be the first place you should look for breaking news about an emergency.
Notes - What you will find in REMM:Radiation principles (e.g., exposure vs contamination)Patient management algorithmsInitial onsite activitiesDecontamination proceduresAssess internal contaminationCountermeasures
“These tools can also be used to improve preparedness by linking the public with day-to-day, real-time information about how their community’s health care system is functioning. For example, emergency room and clinic waiting times are already available in some areas of the country through mobile-phone applications, billboard Really Simple Syndication (RSS) feeds, or hospital tweets. Routine collection and rapid dissemination of these measures of strain on a health care system can inform decision making by patients and health care providers and administrators. Monitoring this important information through the same social channels during an actual disaster may help responders verify whether certain facilities are over-loaded and determine which ones can offer needed medical care.” (Merchant, 2011)
Note: would be ideal for a disaster relief worker traveling to a foreign country and needing to acclimatize quickly to an unfamiliar environment.
ISID (International Society for Infectious Diseases) ProMED-mail (Program for MonitoringEmerging Diseases). ProMED-Mail is also a surveillance tool.
RSS: Really Simple SyndicationSubscribe to “feeds” from websites (look for the orange RSS icon)Use a feed reader (or aggregator) to read and organize your subscriptions. Many disaster health information sources produce RSS feeds. Subscribe to their feeds to monitor all web activity from a single site. So rather than visiting every site to see if there are any updates, just go to your feed reader.
Here is a sample of some RSS feeds producing disaster health information, news, and surveillance data.
Twitter is a microblogging service, which means that people can use it to post very short messages. Some people might think of Twitter as a source for trivial news, but it tends to have very up to date information because it doesn’t take long to compose a short message. Also, it is indexed by Google in real-time which means that it is a good place to look for breaking news. You may see news from emergency managers and first responders before an event has been covered by journalists. Just remember that the information isn’t fact-checked the way a news article would be. Many government institutions are now using it, and tweets are being archived by the Library of Congress. Some institutions use Twitter to post a link to each new piece of content that they post, which makes it kind of like an RSS feed, too. You can usually find an institution’s Twitter account by looking for a blue T or a blue bird on their website—the symbols aren’t as consistent as they are for RSS.
Widgets display third party content on your website. They are an effective way to share information on your library’s website, blog or wiki.
Also mention the MLA’s Moodle page for the course.