Nathan A. Bostick

Disaster Triage Systems for Large-scale Catastrophic Events

Large-scale catastrophic events typically result in a scarcity of essential medical resources and accordingly necessitate the implementation of triage management policies to minimize preventable morbidity and mortality. Accomplishing this goal requires a reconceptualization of triage as a population-based systemic process that integrates care at all points of interaction between patients and the health care system. This system identifies at minimum 4 orders of contact: first order, the community; second order, prehospital; third order, facility; and fourth order, regional level. Adopting this approach will ensure that disaster response activities will occur in a comprehensive fashion that minimizes the patient care burden at each subsequent order of intervention and reduces the overall need to ration care. The seamless integration of all orders of intervention within this systems-based model of disaster-specific triage, coordinated through health emergency operations centers, can ensure that disaster response measures are undertaken in a manner that is effective, just, and equitable.

HIV Screening Practices and Hospital Characteristics in the U.S., 2009-2010

Objectives. The Centers for Disease Control and Prevention recommends HIV screening in U.S. health-care settings unless providers document a yield of undiagnosed HIV infections of <1 per 1,000 population. However, implementation of this guidance has not been widespread and little is known of the characteristics of hospitals with screening practices in place We assessed how screening practices vary with hospital characteristics. Methods. We used a national hospital survey of HIV testing practices, linked to HIV prevalence for the county, parish, borough, or city where the hospital was located, to assess HIV screening of some or all patients by hospitals. We used multivariate logistic regression analysis to assess the association between screening practices and hospital characteristics that were significantly associated with screening in bivariate analyses. Results. Of 376 hospitals in areas of prevalence ≥0.1%, only 25 (6.6%) reported screening all patients for HIV and 131 (34.8%) reported screening some or all patients Among 638 hospitals included, screening some or all patients was significantly (p<0.05) more common at teaching hospitals, hospitals with higher numbers of annual admissions, and hospitals with a high proportion of Medicaid admissions. In multivariable analysis, screening some or all patients was independently associated with admitting more than 15% of Medicaid patients and receiving resources or reimbursement for screening tests. Conclusion. We found that few hospitals surveyed reported screening some or all patients, and failure to screen is common across all types of hospitals in all regions of the country. Expanded reimbursement for screening may increase compliance with the recommendations.

Results of Rapid Needs Assessments in Rural and Urban Iowa Following Large-scale Flooding Events in 2008

BACKGROUND On June 8 and 9, 2008, more than 4 inches of rain fell in the Iowa-Cedars River Basin causing widespread flooding along the Cedar River in Benton, Linn, Johnson, and Cedar Counties. As a result of the flooding, there were 18 deaths, 106 injuries, and over 38,000 people displaced from their homes; this made it necessary for the Iowa Department of Health to conduct a rapid needs assessment to quantify the scope and effect of the floods on human health. METHODS In response, the Iowa Department of Public Health mobilized interview teams to conduct rapid needs assessments using Geographic Information Systems (GIS)-based cluster sampling techniques. The information gathered was subsequently employed to estimate the public health impact and significant human needs that resulted from the flooding. RESULTS While these assessments did not reveal significant levels of acute injuries resulting from the flood, they did show that many households had been temporarily displaced and that future health risks may emerge as the result of inadequate access to prescription medications or the presence of environmental health hazards. CONCLUSIONS This exercise highlights the need for improved risk communication measures and ongoing surveillance and relief measures. It also demonstrates the utility of rapid needs assessment survey tools and suggests that increasing use of such surveys can have significant public health benefits.