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Safer homes, stronger communities: a handbook for reconstructing after disasters was developed to assist policy makers and project managers engaged in large-scale post-disaster reconstruction programs make decisions about how to reconstruct housing and communities after natural disasters. As the handbook demonstrates, post-disaster reconstruction begins with a series of decisions that must be made almost immediately. Despite the urgency with which these decisions are made, they have long-term impacts, changing the lives of those affected by the disaster for years to come. As a policy maker, you may be responsible for establishing the policy framework for the entire reconstruction process or for setting reconstruction policy in only one sector. The handbook is emphatic about the importance of establishing a policy to guide reconstruction. Effective reconstruction is set in motion only after the policy maker has evaluated his or her alternatives, conferred with stakeholders, and established the framework and the rules for reconstruction. As international experience and the examples in the handbook clearly demonstrate, reconstruction policy improves both the efficiency and the effectiveness of the reconstruction process. In addition to providing advice on the content of such a policy, the handbook describes mechanisms for managing communications with stakeholders about the policy, for improving the consistency of the policy, and for monitoring the policy's implementation and outcomes.

Emergency Operations Centers (EOCs) have been credited with driving the recent successes achieved in the Nigeria polio eradication program. EOC concept was also applied to the Ebola virus disease outbreak and is applicable to a range of other public health emergencies. This article outlines the structure and functionality of a typical EOC in addressing public health emergencies in low-resource settings. It ascribes the successful polio and Ebola responses in Nigeria to several factors including political commitment, population willingness to engage, accountability, and operational and strategic changes made by the effective use of an EOC and Incident Management System. In countries such as Nigeria where the central or federal government does not directly hold states accountable, the EOC provides a means to improve performance and use data to hold health workers accountable by using innovative technologies such as geographic position systems, dashboards, and scorecards.

Background： Due to the floating of the guideline, there is no evidence-based evaluation index on when to start the blood transfusion for patients with hemoglobin （Hb） level between 7 and 10 g/dl. As a restdt, the trigger point of blood transtiision may be different in the emergency use of the existing transfusion guidelines. The present study was designed to evaluate whether the scheme can be safely and effectively used for emergency patients, so as to be supported by multicenter and large sample data in the future. Methods： From June 2013 to June 2014, patients were randomly divided into the experimental group （Peri-operative Transfusion Trigger Score of Emergency [POTTS-E] group） and the control group （control group）. The between-group differences in the patients＇ demography and baseline inlbrmation, mortality and blood transfusion-related complications, heart rate, resting arterial pressure, body temperature, and Hb values were compared. The consistency of red blood cell （RBC） transiiision standards of the two groups of patients with the current blood transfusion guideline, namely the compliance of the guidelines, utilization rate, and per-capita consumption of autologous RBC were analyzed. Results： During the study period, a total of 72 patients were recorded, and 65 of them met the inclusion criteria, which included 33 males and 32 females with a mean age of（34.8 ± 14.6） years. 50 tmderwent abdomen surgery, 4 underwent chest surgery, 11 underwent arms and legs surgery. There was no statistical difference between the two groups for demography and baseline inlbrmation. There was also no statistical differences between the two groups in anesthesia time, intraoperative rehydration, staying time in postanesthetic care unit, emergency hospitalization, postoperative 72 h Acute Physiologic Assessment and Chronic Health Evaluation II scores, blood transliision-related complications and mortality. Only tile POTTS-E group on the 1st postoperative day Hb was lower than group control, P 〈 0.05. POTTS-E group was totally （100%） conlbrmed to the requirements of the transfusion guideline to RBC inliision, which was higher than that of the control group （81.25%）, P 〈 0.01.There were no statistical differences in utilization rates of autologous blood of the two groups; the utilization rates ofallogeneic RBC, total allogeneic RBC and total RBC were 48.48%, 51.5%, and 75.7% in POTTS-E group, which were lower than those of the control group （84.3%, 84.3%, and 96.8%） P 〈 0.05 or P 〈 0.01. Per capita consumption of intraoperative allogeneic RBC. total allogeneic RBC and total RBC were 0 （0, 3.0）, 2.0 （0, 4.0）, and 3.1 （0.81, 6.0） in POTTS-E groups were all lower than those of control group （4.0 [2.0, 4.0], 4.0 [2.0, 6.0] and 5.8 [2.7, 8.2]）, P 〈 0.05 or P 〈 0.00 I. Conclusions： Peri-operative Transfilsion Trigger Score-E evaluation scheme is used to guide the application of RBC. There are no differences in the recent prognosis of patients with the traditional transfusion guidelines. This scheme is sate; Compared with doctor experience-based sub iective assessment, the scoring scheme was closer to patient physiological needs lbr transfusion and more reasonable： Utilization rate and the per capita consumption of RBC are obviously declined, which has clinical significance and is feasible. Based on the abovementioned three points, POTTS-E scores scheme is safe, reasonable, and practicable and has the value tbr carrying out multicenter and large sample clinical researches.

The aim of this study was to review the role of public health emergency operations centers in recent public health emergencies and to identify the barriers and enablers influencing the effective use of a public health emergency operations center (PHEOC) in public health emergency management. A systematic search was conducted in 5 databases and selected grey literature websites. Forty-two articles, consisting of 28 peer-reviewed studies and 14 grey literature sources matched the inclusion criteria. Results suggest that PHEOCs are used to prepare and respond to a range of public health emergencies, including coronavirus disease (COVID-19). Factors found to influence the use of a PHEOC include the adoption of an incident management system, internal and external communications, data management, workforce capacity, and physical infrastructure. PHEOCs play an important role in public health emergency management. This review identified several barriers and enablers to using a PHEOC in public health emergency management. Future research should focus on addressing the barriers to using a PHEOC and looking at ways to evaluate the impact of using a PHEOC on public health emergency outcomes.

The practice of emergency operations often involves the travelling of medical teams and the distribution of medical supplies. In an emergency, such as an earthquake, a medical team often has to visit various hospitals (the customers) one after another in a predetermined sequence in order to perform on-site operations that require certain amounts of medical supplies. Because of their perishable nature, the medical supplies are typically shipped in batches from upstream suppliers and kept at multiple distribution centers during the disaster relief process. The scheduling of the medical teams and the provisioning of the medical supplies give rise to a scheduling problem that involves the timely dispatching of supplies from distribution centers to hospitals in coordination with the scheduling of medical teams so as to minimize the total tardiness of the completions of the operations to be performed. We introduce a mathematical programming based rolling horizon heuristic that is able to find near optimal solutions for networks of up to 80 hospitals very fast. We also report on empirical observations with regard to the computational performance of the heuristic; we consider 5420 randomly generated test cases as well as a case that is based on an actual hospital-distribution center network in the greater New York metropolitan area. Managerial insights are drawn from numerical studies regarding the benefits of pre-positioning medical supplies at the distribution centers.

Facing an emerging COVID-19 outbreak in our city, we feared that the same situation could overwhelm our ED resources [1]. [...]we sought to create an area adjacent to our existing ED where patients not requiring emergency level care could be evaluated, tested for COVID-19, and safely discharged home. CDM provided strategic planning for the Clinic's interface with the COVID-response of the health system and facilitated infection control recommendations. Transforming the ambulance bay into a functional Clinic required close and rapid collaboration with hospital leadership, the environmental services department, buildings and grounds staff, infection control experts, and a materials management team.

PurposeIn Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany.MethodsAll emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios.ResultsDuring the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders.ConclusionThis analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.

The COVID-19 pandemic has significantly changed life and work patterns and reshaped the healthcare industry and public health strategies. It posed considerable challenges to public health emergency operations centers (PHEOCs). In this period, digital technologies such as modeling, simulation, visualization, and mapping (MSVM) emerged as vital tools in these centers. Despite their perceived importance, the potential and adaptation of digital tools in PHEOCs remain underexplored. This study investigated the application of MSVM in the PHEOCs during the pandemic in Canada using a questionnaire survey. The results show that digital tools, particularly visualization and mapping, are frequently used in PHEOCs. However, critical gaps, including data management issues, technical and capacity issues, and limitations in the policy-making sphere, still hinder the effective use of these tools. Key areas identified in this study for future investigation include collaboration, interoperability, and various supports for information sharing and capacity building.

Background. The current West African outbreak of the Ebola virus disease (EVD) began in Guinea in December 2013 and rapidly spread to Liberia and Sierra Leone. On 20 July 2014, a sick individual flew into Lagos, Nigeria, from Monrovia, Liberia, setting off an outbreak in Lagos and later in Port Harcourt city. The government of Nigeria, supported by the World Health Organization and other partners, mounted a response to the outbreak relying on the polio program experiences and infrastructure. On 20 October 2014, the country was declared free of EVD. Methods. We examined the organization and operations of the response to the 2014 EVD outbreak in Nigeria and how experiences and support from the country's polio program infrastructure accelerated the outbreak response. Results. The deputy incident manager of the National Polio Emergency Operations Centre was appointed the incident manager of the Ebola Emergency Operations Centre (EEOC), the body that coordinated and directed the response to the EVD outbreak in the country. A total of 892 contacts were followed up, and blood specimens were collected from 61 persons with suspected EVD and tested in designated laboratories. Of these, 19 (31%) were positive for Ebola, and 11 (58%) of the case patients were healthcare workers. The overall case-fatality rate was 40%. EVD sensitization and training were conducted during the outbreak and for 2 months after the outbreak ended. The World Health Organization deployed its surveillance and logistics personnel from non-Ebola-infected states to support response activities in Lagos and Rivers states. Conclusions. The support from the polio program infrastructure, particularly the coordination mechanism adopted (the EEOC), the availability of skilled personnel in the polio program, and lessons learned from managing the polio eradication program greatly contributed to the speedy containment of the 2014 EVD outbreak in Nigeria.

OBJECTIVES This study aimed to elucidate the outcomes of emergency salvage surgery following life-threatening events (serious haemorrhage and/or infections) among patients with lung cancer who had undergone chemo- and/or radiotherapy. Materials and Methods We analysed the data of patient from 2015 to 2020, retrospectively. The clinical characteristics, including preoperative treatment, perioperative outcomes and survival time, were analysed. RESULTS Of the 862 patients who underwent primary lung cancer surgeries, 10 (1.2%) underwent emergency surgeries. The preoperative clinical characteristics were: median age, 63.7 years [interquartile range (IQR) 55–70.5]; sex (male/female), 9/1; clinical staging before initial treatment (I/II/III/IV), 1/1/3/5; initial treatment (chemoradiotherapy/chemotherapy/proton beam therapy), 5/4/1; and indications for emergency surgery (lung abscess/lung abscess with haemoptysis/haemoptysis/empyema), 5/3/1/1. The selected procedures and results were as follows: lobectomy/bilobectomy/pneumonectomy, 8/1/1 (all open thoracotomies); median operation time, 191.0 min (IQR 151–279); median blood loss, 1071.5 ml (IQR 540–1691.5); postoperative severe complications, 3 (30%); hospital mortality, none; median postoperative hospital stay, 37 days (12–125); control of infection and/or haemoptysis, all the cases; final outcome (alive/dead), 3/7 (all the cancer deaths); median postoperative survival, 9.4 months (IQR 4.3–20.4); and median survival from initial treatment, 19.4 months (IQR 8.0–66.9). CONCLUSIONS Emergency salvage lung resection is a technically challenging procedure; however, the results were feasible and acceptable when the surgical indication, procedure and optimal timing were considered carefully by a multidisciplinary team. Although the aim was palliation, some patients who received additional chemotherapy afterwards and, thus, had additional survival time.