Publications

2021
Scott A. Goldberg, Rebecca E. Cash, Gregory Peters, Scott G.Weiner, P. Gregg Greenough, and Raghu Seethala. 2021. “The impact of COVID‐19 on statewide EMS use for cardiac emergencies and stroke in Massachusetts.” JACEP Open. Publisher's VersionAbstract

Objective

To evaluate the impact of coronavirus disease 2019 (COVID‐19) on emergency medical services (EMS) use for time‐sensitive medical conditions. We examined EMS use for cardiac arrest, stroke, and other cardiac emergencies across Massachusetts during the peak of the COVID‐19 pandemic, evaluating their relationship to statewide COVID‐19 incidence and a statewide emergency declaration.

Methods

A retrospective analysis of all EMS calls between February 15 and May 15, 2020 and the same time period for 2019. EMS call volumes were compared before and after March 10, the date of a statewide emergency declaration.

Results

A total of 408,758 calls were analyzed, of which 49,405 (12.1%) represented stroke, cardiac arrest, or other cardiac emergencies. Average call volume before March 10 was similar in both years but decreased significantly after March 10, 2020 by 18.7% (P < 0.001). Compared to 2019, there were 35.6% fewer calls for cardiac emergencies after March 10, 2020 (153.6 vs 238.4 calls/day, P < 0.001) and 12.3% fewer calls for stroke (40.0 vs 45.6 calls/day, P = 0.04). Calls for cardiac arrest increased 18.2% (28.6 vs 24.2 calls/day, P < 0.001). Calls for respiratory concerns also increased (208.8 vs 199.7 calls/day, P < 0.001). There was no significant association between statewide incidence of COVID‐19 and EMS call volume.

Conclusions

EMS use for certain time‐sensitive conditions decreased after a statewide emergency declaration, irrespective of actual COVID‐19 incidence, suggesting the decrease was related to perception instead of actual case counts. These findings have implications for public health messaging. Measures must be taken to clearly inform the public that immediate emergency care for time‐sensitive conditions remains imperative.

impactcovid19starewideemsrunscardiacstrokema.pdf
Sonny S. Patel, Oleksii Sukhovii, Oleksandr Zvinchuk, Julian H. Neylan, and Timothy Erickson. 2021. “Converging Impact of the Ongoing Conflict and COVID-19 Pandemic on Mental Health and Substance Use Disorders in Ukraine.” Journal of Emergency Management. Read PublicationAbstract

Since the Russian annexation of the Autonomous Republic of Crimea and the subsequent occupation of parts of the Donetsk and Luhansk regions, Ukraine has been facing increasing security and healthcare challenges. The seven-year war in East Ukraine has led to a rise in substance and alcohol use and increasing addiction rates among veterans, internally displaced persons, and civilian survivors. This article examines the combined impact of the ongoing Russo–Ukrainian conflict and COVID-19 pandemic on substance use in Ukraine. It also gives an overview of the institutions in place to monitor and improve mental health in the country. The article highlights the urgent need for further funding and research on substance and alcohol addiction, with vulnerable populations affected by the conflict during the COVID-19 pandemic. Frontline healthcare workers in this region should anticipate an increased burden of patients suffering from substance use disorders who are in need of emergency management intervention and proper behavioral health referrals.

PR Chai, EG Ferro, JM Kirshenbaum, BD Hayes, SE Culbreth, EW Boyer, and TB Erickson. 2021. “In Reply to "Hydroxychloroquine Overdose: What Are the Exact Roles of Diazepam and Potassium Infusion?"” J Med Toxicol, 17, 1, Pp. 85-86.
2020
Amir Khorram-Manesh and Frederick M. Burkle Jr. 12/2020. Emergencies and Public Health Crisis Management-Current Perspectives on Risks and Multiagency Collaboration. MDPI.Abstract

Disasters and public health emergencies are inevitable and can happen anywhere and anytime. However, they can be mitigated and their impacts can be minimized by utilizing appropriate measures in all four different phases of disaster management, i.e., mitigation and prevention, preparedness, response, and recovery. Several factors are crucial for achieving successful disaster management. Altogether, this Issue offers new insights into emergency and public health crisis management from a multiagency perspective and allows discussion about new potential risks; lessons learned; and the introduction of new concepts such as flexible surge capacity, and shows some new aspects of practicing multiagency collaboration before, during, and after disasters and public health emergencies.

emergencies_and_public_health_crisis_management.pdf
Krzysztof Goniewicz, Frederick M. Burkle Jr., and Amir Khorram-Manesh. 12/2020. “Implications and limitations of Social Distancing Strategies (SDS) to mitigate the impact of COVID-19 pandemic.” Disaster Medicine and Public Health Preparedness. implications-and-limitations-of-social-distancing.pdf
Erica Nelson, Saira Khan, Swapna Thorve, and P. Gregg Greenough. 12/2020. “Modeling pastoralist movement in response to environmental variables and conflict in Somaliland: Combining agent-based modeling and geospatial data.” PLOS ONE.Abstract

This study explores how pastoralists respond to changing environments in Somaliland . An agent-based model is used to simulate the movement of nomadic pastoralists based on typologically diverse, historical data of environmental, interpersonal, and transactional variables in Somaliland and Puntland between 2008 and 2018. Through subsequent application of spatial analysis such as choropleth maps, kernel density mapping, and standard deviational ellipses, we characterize the resultant pastoralist population distribution in response to these variables.

modeling_nomadic_pastoral_migration_conflict_environment.pdf
Amir Khorram-Manesh, Frederick M. Burkle Jr., Phatthranit Phattharapornjaroen, Milad Ahmadi Marzaleh, Mohammed Al Sultan, Matti Mantysaari, Eric Carlström, Krzysztof Goniewicz, Emelia Santamaria, John David Comandante, Robert Dobson, Boris Hreckovski, Glenn-Egil Torgersen, Luc J. Mortelmans, Mirjam de Jong, and Yohan Robinson. 11/2020. “The Development of Swedish Military Healthcare System: Part II-Re-evaluating the Military and Civilian Healthcare Systems in Crises Through a Dialogue and Study Among Practitioners.” Military Medicine.Abstract

Introduction: Historical changes have transformed Sweden from being an offensive to a defensive and collaborative nation with national and international engagement, allowing it to finally achieve the ground for the civilian–military collaboration and the concept of a total defense healthcare. At the same time, with the decreasing number of international and interstate conflicts, and the military’s involvement in national emergencies and humanitarian disaster relief, both the need and the role of the military healthcare system within the civilian society have been challenged. The recent impact of the COVID-19 in the USA and the necessity of military involvement have led health practitioners to anticipate and re-evaluate conditions that might exceed the civilian capacity of their own countries and the need to have collaboration with the military healthcare. This study investigated both these challenges and views from practitioners regarding the benefits of such collaboration and the manner in which it would be initiated.

Material and Method: A primary study was conducted among responsive countries using a questionnaire created using the Nominal Group Technique. Relevant search subjects and keywords were extracted for a systematic review of the literature, according to the PRISMA model.

Results: The 14 countries responding to the questionnaire had either a well-developed military healthcare system or units created in collaboration with the civilian healthcare. The results from the questionnaire and the literature review indicated a need for transfer of military medical knowledge and resources in emergencies to the civilian health components, which in return, facilitated training opportunities for the military staff to maintain their skills and competencies.

Conclusions: As the world witnesses a rapid change in the etiology of disasters and various crises, neither the military nor the civilian healthcare systems can address or manage the outcomes independently. There is an opportunity for both systems to develop future healthcare in collaboration. Rethinking education and training in war and conflict is indisputable. Collaborative educational initiatives in disaster medicine, public health and complex humanitarian emergencies, international humanitarian law, and the Geneva Convention, along with advanced training in competency-based skill sets, should be included in the undergraduate education of health professionals for the benefit of humanity.

thedevelopmentofswedishmilitaryhealthcaresystem_partii.pdf
Robert I.S. Macpherson and Frederick M. Burkle Jr. 11/2020. “Humanitarian Aid Workers: The Forgotten First Responders.” Prehospital and Disaster Medicine. Read PublicationAbstract

Humanitarian aid workers are an overlooked population within the structure of posttraumatic stress disorder (PTSD) research and assistance. This negligence is an industry-wide failure to address aid workers’ psychological health issues. The suspected numbers of death by suicide, diagnosed PTSD, depression, anxiety disorders, hazardous alcohol and drug consumption, emotional exhaustion, and other stress-related problems are impossible to quantify but are considered endemic. Tools for establishing organizational frameworks for mental health and psychosocial support are readily available. However, the capacity to implement this assistance requires the creation and practice of an open and non-judgmental culture, based on the realistic acceptance that aid work has become inherently dangerous. The possibility of developing a psychological problem because of aid work has increased along with the rise in levels of disease, injury, kidnapping, and assault. As a result, expressions of traumatic stress have become the norm rather than an exception. This commentary outlines the essential steps and components necessary to meet these requirements.

MPH P. Gregg Greenough, MD, Ravi Goyal, Ruwan Ratnayake, Fatma Rawashdeh, Raeda AbuAlRub, Nahla Al-Ali, Muhammad Fawad, and Mohammad Bani Han. 10/14/2020. “Access to Care and Prevalence of Hypertension and Diabetes Among Syrian Refugees in Northern Jordan.” JAMA Network Open. Publisher's VersionAbstract

Importance  The management of noncommunicable diseases in humanitarian crises has been slow to progress from episodic care. Understanding disease burden and access to care among crisis-affected populations can inform more comprehensive management.

Objective  To estimate the prevalence of hypertension and diabetes with biological measures and to evaluate access to care among Syrian refugees in northern Jordan.

Design, Setting, and Participants  This cross-sectional study was undertaken from March 25 to April 26, 2019, in the districts of Ramtha and Mafraq, Jordan. Seventy clusters of 15 households were randomly sampled, and chain referral was used to sample Syrian households, representative of 59 617 Syrian refugees. Adults were screened and interviewed about their access to care. Data analysis was performed from May to September 2019.

Exposures  Primary care delivered through a humanitarian organization since 2012.

Main Outcomes and Measures  The main outcomes were self-reported prevalence of hypertension and diabetes among adults aged 18 years or older and biologically based prevalence among adults aged 30 years or older. The secondary outcome was access to care during the past month among adults aged 18 years or older with a diagnosis of hypertension or diabetes.

Results  In 1022 randomly sampled households, 2798 adults aged 18 years or older, including 275 with self-reported diagnoses (mean [SD] age, 56.5 [13.2] years; 174 women [63.3%]), and 915 adults aged 30 years or older (608 women [66.5%]; mean [SD] age, 46.0 [12.8] years) were screened for diabetes and hypertension. Among adults aged 18 years or older, the self-reported prevalence was 17.2% (95% CI, 15.9%-18.6%) for hypertension, 9.8% (95% CI, 8.6%-11.1%) for diabetes, and 7.3% (95% CI, 6.3%-8.5%) for both conditions. Among adults aged 30 years or older, the biologically based prevalence was 39.5% (95% CI, 36.4%-42.6%) for hypertension, 19.3% (95% CI, 16.7%-22.1%) for diabetes, and 13.5% (95% CI, 11.4%-15.9%) for both conditions. Adjusted for age and sex, prevalence for all conditions increased with age, and women had a higher prevalence of diabetes than men (adjusted prevalence ratio, 1.3%; 95% CI, 1.0%-1.7%), although the difference was not significant. Complications (57.4%; 95% CI, 51.5%-63.1%) and obese or overweight status (82.8%; 95% CI, 79.7%-85.5%) were highly prevalent. Among adults aged 30 years or older with known diagnoses, 94.1% (95% CI, 90.9%-96.2%) currently took medication. Among adults aged 18 years or older with known diagnoses, 26.8% (95% CI, 21.3%-33.1%) missed a medication dose in the past week, and 49.1% (95% CI, 43.3%-54.9%) sought care in the last month.

Conclusions and Relevance  During this protracted crisis, obtaining care for noncommunicable diseases was feasible, as demonstrated by biologically based prevalence that was only moderately higher than self-reported prevalence. The high prevalence of complications and obese or overweight status, however, suggest inadequate management. Programs should focus on reinforcing adherence and secondary prevention to minimize severe morbidity.

accesscareprevalencehtndmsyrianrefugeesnojordan-jamanetopen-2020.pdf
Krzysztof Goniewicz, Mariusz Goniewicz, Frederick M. Burkle Jr., and Amir Khorram-Manesh. 10/2020. “The Impact of Experience, Length of Service, and Workplace Preparedness in Physicians' Readiness in the Response to Disasters.” Journal of Clinical Medicine.Abstract
With an increasing number of natural and man-made disasters, the need for preparedness in all levels of management is obvious. Among healthcare professionals responding to these emergencies, physicians are of particular importance due to their significant roles as leaders and frontline workers in minimizing morbidity and mortality of the affected population. This study analyses the preparedness of 549 physicians from all medical centers in Lublin, Poland to formulate their observations, suggestions, and recommendations concerning the improvement of the chain of response in disaster management. The results of this study show that the perceived preparedness of physicians for disaster management and response is not as high as it should be, and the majority of the respondents perceived their disaster preparedness insufficient. Training of physicians in disaster management and principles of disaster medicine is needed, by focusing on the specificity of rescue response to emergencies following disasters, and medical and non-medical aspects of the response with particular emphasis on a management approach covering all hazards.
theimpactofexperience.pdf
Phuong Pham, Vincenzo Bollettino, Patrick Vinck, Ariana Marnicio, Lea Ivy Manzanero, Mark Toldo, Rachel Dickinson, Alexis Smart, and Evan Bloom. 10/2020. “Network Analysis of Actors Working to Support Disaster Preparedness and Resilience in the Philippines”.Abstract
The Harvard Humanitarian Initiative (HHI) partnered with Root Change to conduct a network analysis of actors working to support disaster preparedness and resilience in the Philippines. The study design is modeled after a summative phase external evaluation that HHI conducted in 2016-2017 on the START Network’s Disasters and Emergency Preparedness Program (DEPP). Network analysis techniques applied in this evaluation have been adapted from the DEPP work to analyze the disaster resilience network in coastal Bangladesh under the Resilient Communities Program. In this report, we present the network analysis and methods used. We also detail findings and recommendations for HHI and other in-country partners about how these results can inform programs to strengthen disaster resilience and climate change in the Philippines.
ph_drr_network_analysis_hhi_2020.pdf
Amir Khorram-Manesh and Frederick M. Burkle Jr. 10/2020. “Sustainability Editorial Disasters and Public Health Emergencies-Current Perspectives in Preparedness and Response.” Sustainability. Read PublicationAbstract

Disasters and public health emergencies are inevitable and can happen anywhere and anytime. However, they can be mitigated and their impacts can be minimized by utilizing appropriate measures in all four different phases of disaster management, i.e., mitigation and prevention, preparedness, response, and recovery. Several factors are crucial for achieving successful disaster management. In the mitigation and preparation phase, all risks should be reviewed and new ones should be added and analyzed carefully to propose proper solutions and plans. In the preparedness phase, the ability and knowledge of each organization and all individuals in the management system should be tested and evaluated to ensure good readiness in responding to an emergency. Furthermore, plans should be available at all levels of the emergency chain of action to cope with all issues in the response and recovery phases [1,2]. This Issue of Sustainability aimed to cover emergency and public health crisis management from a multiagency perspective, by discussing lessons learned, introducing new ideas about flexible surge capacity, and showing the way it can practice multiagency collaboration.

Frederick M. Burkle Jr., David A. Bradt, Joseph Green, and Benjamin J. Ryan. 10/2020. “Global Public Health Database Support to Population-Based Management of Pandemics and Global Public Health Crises, Part II: The Database.” Prehospital and Disaster Medicine. Read PublicationAbstract

This two-part article examines the global public health (GPH) information system deficits emerging in the coronavirus disease 2019 (COVID-19) pandemic. It surveys past, missed opportunities for public health (PH) information system and operational improvements, examines current megatrend changes to information management, and describes a new multi-disciplinary model for population-based management (PBM) supported by a GPH Database applicable to pandemics and GPH crises.

Frederick M. Burkle Jr., David A. Bradt, and Benjamin J. Ryan. 10/2020. “Global Public Health Database Support to Population-Based Management of Pandemics and Global Public Health Crises, Part I: The Concept.” Prehospital and Disaster Medicine. Read PublicationAbstract
This two-part article examines the global public health (GPH) information system deficits emerging in the coronavirus disease 2019 (COVID-19) pandemic. It surveys past, missed opportunities for public health (PH) information system and operational improvements, examines current megatrend changes to information management, and describes a new multi-disciplinary model for population-based management (PBM) supported by a GPH Database applicable to pandemics and GPH crises.
Krzysztof Goniewicz, Frederick M. Burkle Jr., and Amir Khorram-Manesh. 9/2020. “The gap of knowledge and skill – One reason for unsuccessful management of mass casualty incidents and disasters.” American Journal of Emergency Medicine. gap of knowledge and skill.pdf
Sonny Patel, Omar Moncayo, Kristina Conroy, Doug Jordan, and Timothy Erickson. 9/2020. “The Landscape of Disinformation on Health Crisis Communication During the COVID-19 Pandemic in Ukraine: Hybrid Warfare Tactics, Fake Media News and Review of Evidence.” Journal of Science Communication. Read PublicationAbstract

The COVID-19 pandemic has impacted the world in ways not seen since the 1918–1920 Spanish Flu. Disinformation campaigns targeting health crisis communication during this pandemic seek to cripple the medical response to the novel coronavirus and instrumentalize the pandemic for political purposes. Propaganda from Russia and other factions is increasingly infiltrating public and social media in Ukraine. Still, scientific literature has only a limited amount of evidence of hybrid attacks and disinformation campaigns focusing on COVID-19 in Ukraine. We conducted a review to retrospectively examine reports of disinformation surrounding health crisis communication in Ukraine during the COVID-19 response. Based on the themes that emerged in the literature, our recommendations are twofold: 1) increase transparency with verified health crisis messaging and, 2) address the leadership gap in reliable regional information about COVID-19 resources and support in Ukraine.

Asha Devereaux, Holly Yang, Gilbert Seda, Viji Sankar, Ryan C. Maves, Navaz Karanjia, John Scott Parrish, Christy Rosenberg, Paula Goodman-Crews, Lynette Cederquist, Frederick M. Burkle Jr., Jennifer Tuteur, Chiara Leroy, and Kristi L. Koenig. 9/2020. “Optimizing Scarce Resource Allocation During COVID-19: Rapid Creation of a Regional Health-Care Coalition and Triage Teams in San Diego County, California.” Disaster Medicine and Public Health Preparedness. Read PublicationAbstract

Successful management of an event where healthcare needs exceed regional healthcare capacity requires coordinated strategies for scarce resource allocation. Publications for rapid development, training, and coordination of regional hospital triage teams manage the allocation of scarce resources during COVID-19 are lacking. Over a period of 3 weeks, over 100 clinicians, ethicists, leaders, and public health authorities convened virtually to achieve consensus on how best to save the most lives possible and share resources. This is referred to as population-based crisis management. The rapid regionalization of 22 acute care hospitals across 4500 square miles in the midst of a pandemic with a shifting regulatory landscape was challenging, but overcome by mutual trust, transparency, and confidence in the public health authority. Because many cities are facing COVID-19 surges, we share a process for successful rapid formation of healthcare care coalitions, Crisis Standard of Care, and training of Triage Teams. Incorporation of continuous process improvement and methods for communication is essential for successful implementation. Utilization of our regional healthcare coalition communications, incident command system, and the crisis care committee helped mitigate crisis care in the San Diego and Imperial County region as COVID-19 cases surged and scarce resource collaborative decisions were required.

Ann M. Nguyen, Attila J. Hertelendy, Melinda Ashton, and Frederick M. Burkle Jr. 9/2020. “Workflow Solutions for Primary Care Clinic Recovery During the COVID-19 Pandemic: A Primer.” Journal of Public Health Management and Practice. workflowpatternsforofficesincovid.pdf
Alan Parnell, Krzysztof Goniewicz, Amir Khorram-Manesh, Frederick M. Burkle Jr., Ahmed Al-Wathinani, and Attila J. Hertelendy. 8/2020. “COVID-19 a health reform catalyst? -Analyzing single-payer options in the U.S.: Considering economic values, recent proposals, and existing models from abroad.” Journal of Hospital Administration.Abstract

The United States has continued to face severe health coverage and spending challenges that have been attributed to a fragmented multi-payer and fee-for-service delivery system which has become even more exposed by the COVID-19 pandemic. Legislators and healthcare professionals have tried to answer the challenges faced by the U.S. health system through the introduction of several state and federal proposals for a "Medicare-for-all" like system, which have failed to be adopted likely due to the lack of consideration for free-market economic values. Looking to existing models abroad can provide the U.S. with different ways to understand how to achieve the benefits of single-payer models with universal coverage while maintaining the integrity of free-market values. The health systems in wealthy, industrialized countries are closely referenced in this article because of the variation of methods in which each achieves a single-payer/universal coverage model as well as the contrast in their health outcomes compared to that of the U.S. The biggest considerations for any reform effort to achieve an efficient single-payer system with universal coverage is the maintenance of private health insurers and the degree to which expanded government influence would be accepted. The future state of health care remains uncertain and unstable as a result of the COVID-19 pandemic, therefore a window of opportunity exists now for leveraging this uncertainty to achieve reform.

COVID-19 a health reform catalyst.pdf
Attila J. Hertelendy, Gregory R. Ciottone, Cheryl L. Mitchell, Jennifer Gutberg, and Frederick M. Burkle Jr. 8/2020. “Crisis Standards of Care in a Pandemic: Navigating the Ethical, Clinical, Psychological, and Policy-making Maelstrom.” International Journal for Quality in Health Care.Abstract

The COVID-19 pandemic has caused clinicians at the frontlines to confront difficult decisions regarding resource allocation, treatment options, and ultimately the life-saving measures that must be taken at the point of care. This article addresses the importance of enacting Crisis Standards of Care (CSC) as a policy mechanism to facilitate the shift to population-based medicine. In times of emergencies and crises such as this pandemic, the enactment of CSC enables concrete decisions to be made by governments relating to supply chains, resource allocation, and provision of care to maximize societal benefit. This shift from an individual to a population-based societal focus has profound consequences on how clinical decisions are made at the point of care. Failing to enact CSC may have psychological impacts for healthcare providers particularly related to moral distress, through an inability to fully enact individual beliefs (individually-focused clinical decisions) which form their moral compass.

crisis_standards_of_care_in_a_pandemic.pdf

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