Ready for the next one? Public health preparedness of hospitals, countries, and collaborators.

Highlights from Disaster Medicine and Public Health Preparedness, 15(4), Aug 2021.




Wang Y-shang, Sun H-jun, Zou J-chen, Ning J, Du Y. Evaluation Model for Hospital Response Capability for Public Health Emergency. Disaster Medicine and Public Health Preparedness. Cambridge University Press; 2021;15(4):403–8.


The authors explore hospital response capability. Using grounded theory, they looked for an objective measure to evaluate hospital preparedness in responding to public health emergencies. The results could be grouped into four main factors: preparation, treatment, emergency awareness, and prehospital first-aid. Here’s a table from the study with a larger description of some of the things that create disaster response capability.

Figure 1. Evaluation Index System.


Their own reported limitations were the biases inherent in self-reports, and the study was cross-sectional, not longitudinal (which they felt would have better reflected response capability). Another potential limitation is that a study done in Chinese hospitals might not easily transfer to systems in other countries. And the methodology of grounded theory is mainly for theory development (see (https://www.sciencedirect.com/topics/neuroscience/grounded-theory for a nice explanation).


However you accept these limitations, this still might not leave you feeling very prepared for the next public health crisis (if the current one ever ends) from a hospital point of view. The last few years have demonstrated that no epidemic can be only local. So a single hospital’s preparedness is only a drop in the bucket. A crisis that crosses international borders needs international involvement. Another article from this same issue, speaks to public health preparedness on a national scale.


 

Haeberer M, Tsolova S, Riley P, Cano-Portero R, Rexroth U, Ciotti M, et al. Tools for Assessment of Country Preparedness for Public Health Emergencies: A Critical Review. Disaster Medicine and Public Health Preparedness. Cambridge University Press; 2021;15(4):431–41.


The question addressed by this paper is, ‘What tools are available to assess a nation’s preparedness for public health crises?’ The background, not unsurprising to anyone who looks at disaster research, is that there isn’t much — “…only limited knowledge”, “…little consensus” “…poorly understood”, etc. The authors reviewed Medline and grey literature, and contacted public health officials in European countries to find available tools. They found 12 tools. Mainly the focus was infections, with some consideration for other events such as radiological and chemical incidents. Most were based on expert opinion, with no clear evidence base or strategic approach. Many were not in formats, such as online tools, easily adaptable to external agencies. While some common elements were found, there was also a large amount of diversity between them.

“The problem lies not in the absence of standards per se, but in the multiplicity of overlapping (and sometimes conflicting) standards.”

The authors made an important distinction between capacity assessment (which is common), and capability assessment (which is not commonly included). In manufacturing terms, capacity is the ability to produce, where capability is about optimizing production (see https://www.termscompared.com/capacity-vs-capability/ for a helpful discussion on these two terms). In disaster studies, this seems to be about the all-important aspect of adaptability, which is often ignored in favour of resources much easier to measure (capacity).


I’ll highlight another article from this issue which addresses an important aspect of disaster preparedness: collaboration.


 

Kim Y, Oh SS, Ku M, Byeon J. Interorganizational Coordination and Collaboration During the 2015 MERS-CoV Response in South Korea. Disaster Medicine and Public Health Preparedness. Cambridge University Press; 2021;15(4):409–15.


It seems a recurring theme that we are not well-prepared (at the hospital level, at the national level, and now with collaborating between organizations). “…roles and responsibilities of health authorities at the national level were fragmented and lacked clarity.”


This study looked at inter organizational connections during the MERS (did you forget that there was another coronavirus?) crisis in 2015 in South Korea. They used social network analysis, which looks at the the number of connections communicated between organizations and compares to the possible number of connections.

“…close coordination among health-care organizations and government agencies, not only at the local and state level, but also at the national level, is critical…”
 

I'll point out a few other articles from this issue. The first illustrates the difficulty of assessing public health preparedness, a continuation of the preceding discussion. Al Harastani et al report on their tool for assessing hospital disaster preparedness (Emergency and Disaster Preparedness at a Tertiary Medical City). Other titles relate to earthquakes (Hattori et al, Cole et al), flooding (Boonyaratkalin et al), hospital mass-casualty training (Azam et al), emergency physician involvement in hospital preparedness (Ryan et al), nursing education (Alkhalaileh), PTSD (Levaot et al, Wagner et al), and of course, COVID (Ak et al, many letters to the editor).


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