Objective: The supply and distribution of mechanical ventilation capacity is of profound importance for planning for severe public health emergencies. However, the capability of US health systems to provide mechanical ventilation for children and adults remains poorly quantified. The objective of this study was to determine the quantity of adult and pediatric mechanical ventilators at US acute care hospitals.

Methods: A total of 5752 US acute care hospitals included in the 2007 American Hospital Association database were surveyed. We measured the quantities of mechanical ventilators and their features.

Results: Responding to the survey were 4305 (74.8%) hospitals, which accounted for 83.8% of US intensive care unit beds. Of the 52 118 full-feature mechanical ventilators owned by respondent hospitals, 24 204 (46.4%) are pediatric/neonatal capable. Accounting for nonrespondents, we estimate that there are 62 188 full-feature mechanical ventilators owned by US acute care hospitals. The median number of full-feature mechanical ventilators per 100 000 population for individual states is 19.7 (interquartile ratio 17.2–23.1), ranging from 11.9 to 77.6. The median number of pediatric-capable device full-feature mechanical ventilators per 100 000 population younger than 14 years old is 52.3 (interquartile ratio 43.1–63.9) and the range across states is 22.1 to 206.2. In addition, respondent hospitals reported owning 82 755 ventilators other than full-feature mechanical ventilators; we estimate that there are 98 738 devices other than full-feature ventilators at all of the US acute care hospitals.

Conclusions: The number of mechanical ventilators per US population exceeds those reported by other developed countries, but there is wide variation across states in the population-adjusted supply. There are considerably more pediatric-capable ventilators than there are for adults only on a population-adjusted basis.

(Disaster Med Public Health Preparedness. 2010;4:199-206)

Objectives: During the 2009 influenza A (H1N1) pandemic, Argentina's Hospital Nacional Profesor Alejandro Posadas, a referral center in the capital province of Buenos Aires, treated a large urban patient population. Beginning in April, after severe influenza had been reported in North America but before any suspected cases of H1N1 had been reported in Argentina, the authors formed a pandemic planning committee to direct our hospital's response. An important strategy of the management team was to create a single daily monitoring tool that could integrate multiple information sources. We describe our pandemic planning strategy so that it may serve as a template for other hospitals.

Methods: We describe our integrated data management system and the indicators it measured. We also describe the iterative process used to develop these tools and the current versions we use in surveillance for possible new waves of pandemic influenza.

Results: We present 3 examples of strategic decision making applied to data from our integrated information system. Daily pandemic surveillance data motivated the planning committee to reallocate hospital resources to care for patients during the peak pandemic period.

Conclusions: This report illustrates the importance of pandemic planning and advanced integrated information tools for management of a health care facility during a pandemic.

(Disaster Med Public Health Preparedness. 2010;4:207-212)

Objectives: The Medical Reserve Corps (MRC) is a national network of community-based units created to promote the local identification, recruitment, training, and activation of volunteers to assist local health departments in public health activities. This study aimed to develop a toolkit for MRC coordinators to assess and monitor volunteer units' performance and identify barriers limiting volunteerism.

Methods: In 2008 and 2009, MRC volunteers asked to participate in influenza clinics were surveyed in 7 different locations throughout the United States. Two survey instruments were used to assess the performance of the volunteers who were able to participate, the specific barriers that prevented some volunteers from participating, and the overall attitudes of those who participated and those who did not. Validity and reliability of the instruments were assessed through the use of factor analysis and Cronbach's alpha.

Results: Two survey instruments were developed: the Volunteer Self-Assessment Questionnaire and the Barriers to Volunteering Questionnaire. Data were collected from a total of 1059 subjects, 758 participated in the influenza clinics and 301 were unable to attend. Data from the 2 instruments were determined to be suitable for factor analysis. Factor solutions and inter-item correlations supported the hypothesized domain structure for both survey questionnaires. Results on volunteers' performance were consistent with observations of both local health departments' staff and external observers.

Conclusions: The survey instruments developed for this study appear to be valid and reliable means to assess the performance and attitudes of MRC volunteers and barriers to their participation. This study found these instruments to have face and content validity and practicality. MRC coordinators can use these questionnaires to monitor their ability to engage volunteers in public health activities.

(Disaster Med Public Health Preparedness. 2010;4:213-219)

Objective: To assess how West Nile virus (WNV) was reported to the American public on local television news and identify the main factors that influenced coverage.

Methods: A representative sample of WNV stories that were reported on 122 local television news stations across the United States during October 2002, covering 67% of the nation's population, were coded for self-efficacy, comparative risk scenarios, symptoms and recommendations, high-risk individuals, and frame. In addition, public service professionals (PSPs) interviewed in the segments were identified. Comparisons were made between stories in which a PSP was interviewed and stories without an interview with respect to discussion of the 5 variables coded.

Results: Of the 1371 health-related stories captured during the study period, 160 WNV stories aired, the second most common health topic reported. Forty-nine of the 160 WNV stories contained at least 1 of the 5 reporting variables. Forty-two PSPs were interviewed within 33 unique WNV stories. Public health officials composed 81% of all PSP interviews. Stories containing a public health official interview had 15.2 times (odds ratio 15.2, confidence interval 5.1-45.9) higher odds of reporting quality information, controlling for station affiliate or geographic location.

Conclusions: Emerging infectious disease stories are prominently reported by local television news. Stories containing interviews with public health officials were also much more likely to report quality information. Optimizing the interactions between and availability of public health officials and the local news media may enhance disaster communication of emerging infections.

(Disaster Med Public Health Preparedness. 2010;4:220-225)

Background: A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning.

Methods: We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data.

Results: Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care.

Conclusions: Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major incident.

(Disaster Med Public Health Preparedness. 2010;4:226-231)

Infectious diseases following natural disasters tend to occur as a result of the prolonged secondary effects of the disaster, mostly when there is an interruption of public health measures resulting from destruction of the local infrastructure. This article will review the infectious risks that occur as a result of natural disasters, with a focus on the mechanism of disease spread, infectious diseases after specific disasters, and various evidence-based interventions.

(Disaster Med Public Health Preparedness. 2010;4:232-238)

Families with children with special health care needs may present a challenge for disaster responders. This study examined the level of personal disaster preparedness among this at-risk population in relation to the general population, and explores whether special health care needs or perception of disaster risk affects preparedness levels. A convenience sample of 145 families presenting to an urban tertiary care children's hospital was surveyed using a previously validated instrument to gather information on levels of preparedness and factors influencing preparedness. In spite of significant special health care needs and concern about disasters, families remain unprepared for a disaster event. Health care and psychosocial support workers are in a unique position to increase preparedness levels in this at-risk population.

(Disaster Med Public Health Preparedness. 2010;4:240-245)

Vulnerable populations tend to have the worst health outcomes during and after disasters; however, these populations are rarely included in the emergency planning process. In Philadelphia, the Department of Public Health and the Office of Emergency Management have reached out to community-based organizations that serve vulnerable populations to include these key stakeholders in emergency planning. In this article, we outline strategies for locating, engaging, and communicating with vulnerable populations about both organizational and personal emergency preparedness. Such strategies include creating a method for bidirectional communication via a free quarterly health newsletter that is distributed to community-based organizations serving vulnerable populations. We also note successes and next steps from engaging vulnerable populations in the planning process in Philadelphia.

(Disaster Med Public Health Preparedness. 2010;4:246-251)