Information Seeking Behavior and
Viewpoints of Emergency Preparedness and management professionals concerned
with Health and Medicine
Final Report
Prepared for the National Library of Medicine
By
Murray Turoff, turoff@njit.edu http://is.njit.edu/turoff
Starr Roxanne Hiltz, hiltz@njit.edu http://is.njit.edu/turoff
March 6, 2008
Abstract
This is a study for the National Library of Medicine on information requirements for health-related issues in emergency preparedness, management, and response. Results are presented of a designed inquiry based upon returns of 34 professionals working in Emergency Management, Health Care, Academia, Libraries, and International organizations. The emphasis is on determining what sources are now used and what needs are unmet.
Table of Contents
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q5 Current outstanding
examples or missing materials on the Web |
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q6 Roles of
Libraries, Librarians, and Information Specialists |
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5. Examples of
Information Overload Mitigation Activities (Summary) |
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Executive Summary
Introduction
A study for the National Library of Medicine (NLM) was conducted to assess the information requirements for health-related issues in emergency preparedness and response. The overall goal of the study was to identify the views of potential users about the most significant knowledge, information, and services they are seeking, some of which might be incorporated into the development of the Disaster Information Management Research Center (DIMRC) planned by the National Library of Medicine or into other related efforts.
The emphasis of the study was on determining the current information seeking behavior, existing preferred sources of information, and unmet information needs of professionals involved with the medical and public health aspects of emergency planning, preparedness, and response. The report summarizes responses to questions around the following topics: current sources, desired sources, organizing the information, examples of important materials and missing materials on the Web, librarian roles, information needs in extreme events, methods for dealing with information overload and organizing information, international issues, and level of experience with NLM resources. Detailed appendices include examples of grass roots efforts to mitigate information overload, a copy of the self report guide, a complete compilation of responses organized by type of respondent, and a list of international websites compiled by one of the respondents.
The study results address a full range of information needs,
including the formal published literature, comprehensive databases for the
management of specific types of disasters, practice-based documents that are
typical of the gray literature, aids to developing and maintaining practitioner
documents, and improved methods of organizing information of all types. Roles for librarians as well as disaster
community experts were identified for enhancing access to important information
at the time it is needed.
Methodology
Data collection took place during the period September to December 2007. Beginning with an initial list of expert informants identified by NLM and the study investigators, a “snowball” sampling technique was used, in which each expert was asked to suggest other appropriate participants in the study. Approximately 100 professionals involved in emergency preparedness and management were invited to participate. From this pool, there were 34 respondents representing emergency practitioners (7), health-related professionals (10), academics (7), librarians (3), and international professionals (7). All but three respondents provided their name, affiliation, and brief background information and are named as contributors in the report.
Although the initial design was for semi-structured
interviews administered in person or by phone, the investigators found that the
"on the spot" interview process did not obtain the detailed
information about specifics of information seeking behavior that were
desired. The participants needed
time to refer to their materials and reflect on their processes. The approach was therefore modified to
solicit written self-reports in response to the set of questions, which yielded
richer and more relevant information from this process than from the personal
interviews. The methodology is thus most like the first round of a
Findings and Observations
Currently used sources:
Respondents reported use of a diverse range of sources that they consider highly useful and important information for health-related emergency preparedness or response, with the diversity due partly to the varied specializations in particular types of emergencies. Current sources included primarily websites and journals, but other types of print resources were also identified. With the journal literature, there is a tremendous scattering of the literature over many different sources. Hundreds of web sites were mentioned, with little overlap. The most frequently mentioned was the CDC's http://emergency.cdc.gov/ site, with eleven mentions. The next most frequently cited was the Department of Homeland Security general site or its Lessons Learned Information Sharing (LLIS) site, followed by Relief Web. The FEMA and Radiation Event Medical Management (REMM) sites were next, with three mentions each.
What's missing?
Users were also asked about desired resources that are currently lacking or are difficult to use. The practitioners were especially dissatisfied with their ability to get the current information they need, when they need it, and with the ability to know which resources are authoritative. In addition, practitioners, medical professionals, and academic researchers alike expressed the need for more practical, easy to understand information – "useful, real data on real-life emergency situations." Examples included the need for more logistics and management information and for implementation information such as Standard Operating Guidelines and equipment lists. There were also requests for more websites similar to REMM, an “Event Type Information Portal” for radiation events, extended to other types of threats, for best practices summaries to inform about the best way to handle an event, for disaster related assessment instruments, protocols and intervention plans, and for disaster drill data. Other suggestions included more disaster planning and recovery information in the Go Local component of NLM’s MedlinePlus service, an all-hazard core Emergency Operations Plan (EOP) template for public health, and a coherent journal pulling together selected articles that focus on emergency preparedness and response.
Other needed resources deal with the "gray" literature that is not formally published and can exist in either print or web-based form, or both. Many respondents believe this type of literature often contains the most up-to-date and most relevant content. Examples include forms, procedures reports or assessments, operations plans, databases of personnel and other resources, and “best practices” and case reports.
With respect to what is lacking in Web resources, again the responses were diverse, but there was a general feeling that there should be less guidance-related information and more information related to hands on assistance. There were several mentions of the need to use “new media” typical of Web 2.0 and use of cell phones to reach isolated, deep field populations. Needed materials included online training materials and courses; specific compilations of local best practices; actual plans for organizations such as hospitals and community service organizations, schools, and local agencies; and access to information on local response efforts, such as a list of shelters and first responders (with a role for GoLocal mentioned).
In actual emergency situations, participants provided examples of information that was needed but was difficult to obtain. One example dealt with displaced persons standing around the emergency room and not knowing where to go, illustrating the need for up to date information and action advice for a specific emergency and locale. The development of online templates that could be used in any specific disaster to facilitate compilation of such information was suggested. Another example addressed people wading through inches of ash with no information about toxicity and use of safety equipment such as respirators. In another case, physicians caring for people outside their areas of specialty not only needed access to medical and prescription records, but also to quality information health care information, including from previously unauthorized sites.
In extreme emergencies and crisis situations, the need for focused background information in advance of disasters was mentioned in terms of minimizing mortality and morbidity. This information includes baseline health indices, disease prevalence and vaccination coverage, ethnographic data on populations at risk, information on in-country NGOs and UN agencies, the country's disaster plan, logistics information, and in-country capacity for food, drugs, and supplies. Due to the unpredictability of emergency situations, respondents also reported that systems need to be flexible to the needs of rapid specialized information delivery, and the physical communications infrastructure for delivery of this fast breaking information must be considered.
Organization of information:
Regarding the issue of organization of information and methods used to find useful material, respondents emphasized the need to be able to obtain information that is relevant among an abundance of diverse and scattered resources. There is a general feeling that there is better information out there that they have not accessed, information that would enable them to do better plans, improve training, and maker better decisions. A range of tactics to find useful, relevant material were reported, including restriction of inputs to limited sources with good filters; using material that has been vetted by trusted sources; relying on individual contacts; developing classification structures; and seeking specific types of information such as after action reports, reports of best practices, and specific plans. Trust in sources and lack of cooperation or collaboration between different organizations or levels of government were reported as underlying problems. Many different sources are attempting to become the one source that everyone should go to for disaster information, and some respondents felt that this was not a worthy goal given the diversity of topics and problems that are involved.
Regarding ways to better organize resources to reduce the time needed to find useful new material, suggestions included having information specialists retrieve and synthesize relevant information, establishing integrative portals to quality sites for each type of disaster, expanded indexing, and classification systems with expert input, and community-based approaches to organizing material, including use of social tagging to create taxonomies.
Respondents were also asked about what they would like to see represented in an index or ontology of disaster preparedness and response. Ideas about various approaches to organization were offered, but the emphasis was less on the specific content, and more on the need for input from experts (including experienced emergency management practitioners) and for dynamic systems that can evolve to meet changing knowledge and needs.
Library roles:
When asked about current or potential roles of libraries, librarians, and information specialists, there was considerable support for the idea that librarians must become an integral part of the nation's emergency preparedness and response team. Among the suggestions for librarian roles were:
- creating and maintaining taxonomies with expert input;
- serving as a clearinghouse of knowledge concerning the different aspects of disasters;
- equipping libraries to access real-time emergency telemedicine networks;
- working with specialists to identify high-quality information;
- developing easy-to-use methods of delivering specific content;
- producing annotated bibliographies and syntheses;
- participating in call centers taking questions from the public;
- developing FAQs for local emergency preparedness and response and making them easy to locate;
- assisting in text and data mining,
- aggregating and compiling information to support public health decision-making;
- and sharing expertise with those in developing countries through an international network of librarians and archivists.
International issues:
Study participants were also asked about international considerations relevant for NLM. Cultural and language diversity were cited in the context of not relying solely on high tech solutions and the need for culturally appropriate information. Creating an international network that allowed librarians and archivists in developed countries to share expertise with those in developing countries was also suggested. The need for a central point of decision support information was cited, much of which is currently obtained in an ad hoc fashion from various international organizations when a disaster strikes. Examples of ways in which such a resource could facilitate international disaster relief included more targeted intervention; effective stockpiling; geographical pre-positioning; better strategic decision making by senior managers, and improved targeting of rapid health assessments.
Regarding contributions that other countries could make to NLM, respondents reported an abundance of information such as local contingency plans, lessons learned, case studies, and best practices, but noted it is difficult to access, as many of these documents are either not in digital form or are held locally. By providing an example of open document collection, it was observed that NLM could work with other institutions in these countries to encourage and help them to share more widely, thus building recognition for their contributions. Additional specific suggestions included analysis of UN data on medical and public health impacts of disasters, and providing expertise on how to respond when high tech solutions involving use of internet and advanced medical technology fail due to emergency conditions.
Experience with NLM Resources:
Respondents were also asked about their prior experience with MEDLINE/PubMed or
other NLM systems (e.g. WISER, REMM, TOXNET) to find information related to
emergency preparedness or management.
Many had praise for NLM's current services, yet others had limited
experience, especially among the emergency practitioners. One reason suggested for their more
limited use was the lack of information for immediate practical use in
emergency response. The
contributions and importance of NLM were acknowledged by one respondent in this
way: “It would be wonderful if the NLM
were to be asked to join DHS as a full partner in preparing
Cooperation, Coordination, Integration:
In addition to the structured questions, respondents were given the opportunity to provide additional information or comments not addressed by the study instrument. Responses primarily dealt with major process issues that, at least indirectly, lead to problems in the information functions that are necessary to carry out various phases of emergency preparedness and management. These include lack of communication and information exchange between the medical and the community service operations; unclear roles and responsibilities of the federal, state, and local agencies with respect to degree of aid and recovery of the public; the need for improved cooperation and coordination among the various agencies; and more explicit treatment of ethical issues. Though the focus of this needs assessment was in the areas of emergency medical response and public health, the investigators also emphasize that the health and medical areas integrate with a great many other aspects of a disaster, making it difficult to consider issues in isolation from other concerns like infrastructure, living necessities, transportation, and logistics. At least half of the 34 respondents were involved in other areas of emergency preparedness and management.
1. Introduction
The overall goal of this study is to aid in determining the views of potential users about the most significant knowledge, information, and services they are seeking, some of which might be incorporated into the development of the Disaster Information Management Research Center (DIMRC) planned by the National Library of Medicine or into other related efforts. DIMRC should provide aid to practitioners, emergency responders, professionals, managers, and researchers concerned with any of the medical/ public health aspects of Emergency Management and Preparedness.
We were asked to: "assist NLM in determining the current information seeking behavior, existing preferred sources of information, and unmet information needs of people (researchers, practitioners, volunteers, non-profit organizations, local communities, and local, state, and federal government agencies) involved with emergency planning, preparedness and response to disasters with potential or actual medical and public health consequences."
After describing the methodology, the respondents are all briefly described, so that the reader may understand the qualifications of the emergency response professionals who provided the information. Then responses to each of the questions we asked are summarized. Appendix C includes the full set of responses by each of the 34 respondents. This is a long appendix; however we encourage the reader to skim this and to read carefully any of the answers to particular questions that most concern them. Our summaries in the body of this report cannot convey the richness of the ideas and viewpoints and the diversity of interests and concerns in this area of emergency preparedness and management. For anyone seeking to set specific requirements or objectives the actual responses are necessary reading. For those seeking added sources of useful information there is a tremendous list of websites scattered throughout the comments. In addition one of the appendices (D) is a list of well described international websites.
A number of the respondents contributed information on actual activities they are involved with to help handle the information overload problem in this field. A number of these represent grassroots volunteer efforts to aid their fellow professionals in finding useful information. We have specifically included some of these as examples (Appendix A) to illustrate what is taking place. We summarize these (Section 5) after we provide an overview of the individual responses.
One of our respondents (Marv Birnbaum, Professor at the
- Even when considering just journals, there is a tremendous scattering of the literature over many different sources.
- The health and medical areas integrate with a great many other areas of concern in an emergency, so that it is hard to treat many of the areas in isolation from other concerns like infrastructure, living necessities, transportation, and logistics.
2. Methodology
Subjects- Our goal was to obtain information from a small number of expert informants in the various categories of emergency response personnel who might be the consumers and/or the providers of information for DIMRC. The categories that emerged through discussion with NLM and some initial participants in the study are:
a. Emergency Response Managers (with some experience dealing with actual emergencies with public health components).
b. Medical professionals (generally doctors) with some experience with large scale emergency medicine.
c. Academics and librarians working in the area of health-related issues in emergency response and the information systems to support this response.
d. International professionals in any of the above categories (or Americans focused on international activities).
An initial list of identified experts to be invited was developed by NLM supplying some names, mainly of medical professionals and librarians, and by our using our contacts through ISCRAM (Information Systems for Crisis Response and Management) and research in the field (mainly for categories a and d above). Invitations were sent by email, often followed up by telephone. In addition, this can be considered a “snowball” sampling technique, because each expert contacted was asked to suggest other appropriate participants in the study, and in many cases, sent an invitation to participate to their colleagues, at our request. This type of "snowball" sampling works very well in obtaining the cooperation of busy experts and increasing the response effort and rate.
A total of approximately 100 experts were contacted over the period of September through December of 2007. As of this report, we have 34 complete responses. A description of the participants follows. Most of them agreed to inclusion of their name and brief information about their relevant experiences in this report, while a few wish to remain completely anonymous.
Procedure- This study developed and used a new methodology which we tentatively name a “Networking Inquiry.” Initially, we developed an interview guide for semi-structured interviews, with the expectation that it would be administered face to face or by telephone. However, when we administered the first three interviews face to face, we discovered problems with this procedure. First of all, it took almost a full day to travel to the location of the experts, and administer the interview, which took approximately 1 to 1.25 hours. Secondly, transcription of these long interviews was a problem, taking about a day. But most importantly, the interview process did not obtain the detailed information about specifics of their information seeking behavior that we needed. The participants needed to be able to look through their bookmarks online and look up reference materials and think about exactly what sources they were using now, which is not possible with an “on the spot” verbal answer required. And, the personal interview, while it developed rapport, tended to lead to stories of experiences during emergencies that were interesting and informative, but not really the topic of the inquiry.
Thus, we modified the interview guide slightly and turned it into a self report. The self report form for this guided inquiry is attached as Appendix B. Respondents were instructed, “If there is a question that does not apply to you or for which you cannot provide information, just leave it blank." On the other hand, they were requested to give detailed lists, including URLS for web sites, for the resources which they are finding most useful for emergency response management. Questions were dealt with through many email messages and phone calls. When a response was promised but not received within approximately a month, reminders were sent by email.
We obtained much richer and more relevant information from this process than from the personal interviews, and the respondents actually took less time, most completing in under an hour. The information supplied was already in the form of Word or HTML documents and required no transcribing. We call this a “networking inquiry” for two reasons. First, it used computer networks to gather the responses. Second, the sampling method took advantage of the professional social networks of the initially identified experts to obtain additional participants.
The logical next step in this process would be to take the
numerous needs and requirements developed in this document to a larger group of
respondents for evaluation with respect to relative value to the practitioner
community. This would result in a
full scale
Norman Dalkey's early Delphi experiments at RAND showed that three to five experts in a very specific area usually were sufficient to cover the range of qualitative insights about a given issue or topic within their specialty. More experts in the same effort usually led to duplication of insights rather than generating new insights. Our major categories of participants in this qualitative inquiry did satisfy those requirements:
1. Emergency Practitioners and Coordinators (7)
2. Health Related Professionals (10)
3. Researchers/Academics, Librarians (10)
3.1 Librarians (3)
3.2 Academics or Researchers (7)
4. International Professionals (7)
Total 34
The remainder of the body of this report summarizes the responses to the questions asked, in the order in which they were asked. Appendix C gives the complete set of responses to each question, broken down by category of respondent (Emergency response managers, medical personnel, librarians, academic researchers, and international practitioners.)
3. The participants
List of respondents
For the purposes of this summary we have divided the respondents into four categories.
1. Emergency Practitioners and Coordinators
Those actively working in the field and involved in dealing directly with emergencies.
2. Health Related Professionals
Those working as professionals in the health and medical fields who have had some responsibilities and experiences in any phase of emergency preparedness and management.
3. Researchers/Academics, Librarians
Who are or have been working on topics related to emergency planning, management or response with medical or health concerns, but clearly the other two categories are not their primary function. They may also have done some work in either or both of the first two categories. We have noted two sub-categories: Librarians and Academics
4. International professionals
This includes both citizens of foreign countries and Americans who are involved in international emergency management activities, who may fit in any of the above 3 categories.
For each question we have grouped the answers to a given question into one of the categories. This may provide some insight into some of the responses but there are cases of overlap between points made among the four groups.
In the following list when names are given, the respondent gave permission for identification as a participant/ contributor to this study. In some cases anonymity has been preserved due to a request from the contributor.
1. Emergency Practitioners and Coordinators
Gregory T Banner, Regional Emergency Coordinator, Region I
(New England),
Involvement with 911, Katrina, Anthrax, Station Nightclub Fire, Micoplasma Pneumonia outbreak, and others.
John Cizbe, Emergency Planner, Alexandria Health Department; Previously Vice President, Disaster Services, American Red Cross.
Ken Curtin- Currently with FEMA as Voluntary Agency Liaison. There are two parts of the job. One of them is, to try to promote the formation of VOAD, Voluntary Organizations Active in Disasters. Mr. Curtin started working for the Red Cross 35 years ago at disaster sites, for 17 years total. Five or 6 years for FEMA. The other 12 years he worked in international refugee and disaster human services— Catholic Relief Fund, Christian Children’s Fund, etc.
Geoffrey Hoare, Regional Preparedness Planning Coordinator, Domestic Security Task Force Region 3,
Henry Straub- Project Manager for emergency management
services at New Jersey Business Force Organization, which is a planning and
preparedness organization for
Erik R. Janus worked from 1999-2003 as an Environmental Scientist or the US Army Center for Health Promotion & Preventive Medicine. He assisted with technical aspects of long-term recovery phase response to the 2001 attack on the Pentagon. From 2003-2006 he was a Toxicologist with the Michigan Department of Community Health, where he assisted in preparation of agency response plans, including risk communication materials for chemical events.
David Dlugolenski is Senior Manager, Disaster Mitigation, The Port Authority
of NY & NJ, Office of Emergency Management,
Hal Newman is the founder and managing partner of TEMS Inc.,
the managing editor of Big Medicine, and the executive director of the
2. Health Related Professionals
Lewis Goldfrank, MD, Chairperson of the Department of Emergency Medicine at NYU. Numerous R&D efforts, as well as Committees and participation in numerous NYC disaster responses.
Andrew Milsten, MD, Chair of
the ACEP (American College
of Emergency Physicians
Ann E. Norwood, Senior Policy Analyst, HHS/ASPR, Associate Chairman, Department of Psychiatry, USUHS. Experience with Desert Storm, Hurricane Andrew, 911, and Katrina.
David Gruber- Working from present back, he is Senior Assistant Commissioner of Health
Infrastructure Preparedness and Emergency Response at the New Jersey Department
of health and Senior Services.
Prior to that he was Assistant Commissioner for the same role and prior
to that Executive Director. Just
prior to that he was with Dallas county Department of Health and Human Services
in
Eric K. Noji, M.D., Counsel, Office of the Secretary of Defense for Health Affairs, the Pentagon. 25 years in emergency health preparedness and management field, mostly at the Centers for Disease Control and Prevention and the World Health Organization.
Norman Coleman, Senior Medical Advisor, Office of Preparedness and Emergency Operations, Assistant Secretary for Preparedness and Response, HHS. Three years, participation in at least 6 national emergencies and exercises.
Anonymous, Senior Medical Advisor, National Institutes of Health.
James M. Rush, President, MEDLOG Inc.
Prior Experience includes:
- Served the Federal Emergency Management Agency (FEMA) as a healthcare medical logistics subject matter expert for the FEMA course, “Fundamentals of Healthcare Emergency Management, December, 2005
- Project
Officer,
- Project
Officer,
Peter G.
Goldschmidt, President, World Development Group, Inc.
Dr. Goldschmidt is an expert in public health systems
and policies. He is both an MD and
PhD in Public Health. He has been
responsible for a significant number of major policy studies in Healthcare.
3. Librarians and Academics or Researchers
3.1 Librarians
Anonymous: Librarian who assisted in Katrina and serves as an electronic resources librarian in a major metropolitan area.
Deborah Halsted, Associate Director, Public Services and
Operations for the
Kristine Alpi, Associate Library Director,
3.2 Academics or
Researchers
Ann Fruhling, PhD, Assistant Professor
Project Director and Designer for STATPack, Nebraska R&D
effort in use in
John R. Harrald, Professor and Director, Institute for
Crisis Disaster and Risk Management,
Irene Jillson, Ph.D., Assistant Professor,
Julie Dugdale, Ph.D. 2006 – present, researcher with MAGMA-LIG
(Multi-agent systems team - The Grenoble Computer Science Laboratory) and
Lecturer in Artificial Intelligence at Grenoble 2 University, France. 2003 –
2006 Visiting Researcher at IIMH-LIG (Human computer Interface Team, LIG,
Firoz Verjee, Senior Research
Associate at the Institute for Crisis, Disaster & Risk Management,
Valerie I Seefried, MPH, Research Associate & Doctoral Candidate at GWU Institute for Crisis, Disaster & Risk Management (ICDRM); 2004-present; previously Program Coordinator for Homeland Security & Resilience Program – Royal United Services Institute, London UK.
Marv Birnbaum is
a Professor at the
4. Internationally Oriented Contributors
Anonymous, many years of practical experience in the management and design of Humanitarian Information Systems
Hans Zimmermann - Director, Policy and Development, The
International Emergency Management Society (TIEMS);
- International
Coordinator for Emergency Communications, International Amateur Radio
- Chair,
International Chapter, Cellular Emergency Alert Systems Association.
Previously served
as:
- Senior
Humanitarian Affairs Officer, United Nations Office for the Coordination of
Humanitarian Affairs (UN/OCHA);
- Chair, UN Working
Group on Emergency Communications (WGET).
Tanja Pekez-Pavlisko MD,
Mario Kopljar, MD, MSc, General surgeon, with duties in surgical emergency operations, member of Croatian chapter of ITLS (International Trauma Life Support, itrauma.org)
Albert Simard, Project Manager, Modeling Framework, developing a modeling framework for the Canadian Food Inspection Agency. Previous:
- Director,
Knowledge Strategies – Natural Resources
- Director,
Knowledge Management –
Concurrent with above
- Chair, Executive Committee – Global Disaster Information Network
Geert Gijs, Process Manager Incident & Crisis management, Emergency Planning and Disaster Relief Operations, Federal Public Service Health –Belgian Government. Also, Chief Coordinator B-FAST- Federal Public Service Foreign Affairs. International Emergency Management and Disaster Relief, 1999 till present, with emergencies including:
2000 – Earthquake:
2001 – Earthquake:
2003 – Earthquake:
2004/2005 – Tsunami:
HQ Coordinator B-FAST – DVI – Field Hospital – IHP Support
2005 – Earthquake:
2006 – Floods
2006 – Floods
2007 – Floods West Africa –
Dr. Jayanth G Paraki, Independent Research Scientist in
Knowledge Management with Telemedicine as one of the key focus areas. Began a global campaign to mobilize
support for Telemedicine in Disaster Management in 2001 with a paper at the 6th
International Conference on Medical Applications of Telemedicine at
4. Summary of Responses by Question
Question 2: Current Sources of Information
The question asked was:
2. What sources do
you currently consider as highly useful and important for emergency
preparedness or response missions with medical or public health implications
(e.g. including journals, organizations, websites, books, reports, plans,
training materials, services, etc).?
The diversity of sources listed is very great, with some respondents sending us lists or links to hundreds of sources. The only sources that are mentioned by a substantial number of respondents are web sites. Figure 1 profiles the leading three websites, mentioned by at least four of the respondents. The CDC website is by far the most frequently mentioned (11 times, explicitly). This is followed by five mentions of LLIS or a generic “Dept. of Homeland Security” websites. The third most frequently mentioned, especially by international professionals, is Relief Web. Interestingly, FEMA does not make the top three; it is “tied” with REMM, with three mentions (Radiation Event Medical Management- http://www.remm.nlm.gov/ ).
One reason why there is such a diversity is that emergency professionals tend to “specialize” in one type of emergency; so, for instance, those involved with nuclear and radiological incidents will want to go to REMM, while those involved with infectious diseases will choose other websites and sources,. Thus, the types of journals and other non-web sites mentioned are especially diverse. We encourage the reader to at least skim the richness and diversity of the answers to this question in Appendix B. The fact that the most frequent website is only mentioned 11 times out of the 35 respondents is further testimony to this.
Figure 1 gives more details on the "Top 3” web sites mentioned.
Figure 1
Description of the Three Leading/ Most Frequently Mentioned Websites
Related to (Health/ Medical) Emergency Preparedness and Response
1. CDC http://emergency.cdc.gov/
This is part of the CDC site devoted to all kinds of emergency medicine
information, as shown below in the main page.
Agents,
Diseases, & Other Threats
Natural Disasters & Severe
Weather
A notable feature is that it has
separate pages for the general public and for the medical professional, e.g.:
when one of the emergency types is chosen, the information is then broken down
as below.
Bioterrorism
Specific Bioterrorism Agents
Info for the General Public
·
Overview
Info for Professionals
·
Training
·
Lab Info
Related Resources
·
State & Local
Health Departments
2. Lessons Learned
Information Sharing System (www.llis.gov)
LLIS.gov is a national on-line network of lessons
learned and best practices designed to help emergency response providers and
homeland security officials prevent, prepare for, respond to, and recover from
all hazards, including terrorism.
The central component of LLIS.gov is a collection of hundreds of
peer-validated lessons learned and best practices.
It also serves as a central repository of relevant government homeland security documents and events. The system is frequently updated with new reports and publications intended for homeland security personnel.
3.
ReliefWeb www.reliefweb.int
This is the global hub for time-critical humanitarian information on Complex Emergencies and Natural Disasters. It is indexed by country/ location of current emergencies.
Question 3: Desired Sources
The first part of this question asked was about general needs:
3.a. For emergency preparedness or response
missions with medical or public health implications: What useful resources, services, or
types of information are now missing or difficult to access or use, that you
would like to see more readily accessible to all concerned? (Either for a
specific type of medical disaster such as a pandemic flu, and/or for general
health aspects of emergencies;
i.e., disease outbreaks after hurricanes or earthquakes).
The practitioners were especially dissatisfied with their ability to get the current information they need, when they need it. As one emergency management professional put it: “I think the problem is not resources, it is finding the right ones and then knowing which resources are authoritative. A web search on any given topic will likely turn up multiple resources.” Another emergency manager described specifics related to this as “Easily accessible lists of potential contractors sorted by actual (rather than professed), proven areas of expertise; coherent journal pulling together selected articles that focus on emergency preparedness and response from a wealth of sources (e.g., public health-related journals) in which those articles may be buried.”
A third noted that an unmet need is “Information about what other organizations are doing. What supplies, equipment, medications and personnel are “in the pipeline” on route to a disaster scene. Unfortunately, we are still depending on traditional (read: antiquated) means of communication.” A fourth wants more “Disaster ‘After Action Reports’, especially where lessons were NOT learned and the same deficiencies were present over time.” This need for the “nitty gritty” details are also expressed by a fifth practitioner: “What FEMA planning course calls “implementing information” Standard Operating Guidelines (SOGs), equipment lists, job action sheets, MOUs (Memorandum of Understanding). There is a lot of clinical information, much of which is redundant, and not enough logistics and management info (by comparison).”
The phrase “easily accessible” includes the need for medically related information in a form comprehensible by the layperson. A practitioner dealing with radiation and nuclear related emergencies noted, “Rad/nuc info is difficult to aggregate and find. Needs to be made intellectually accessible to those without radiation expertise. Using multimedia helps as this area is very technical.”
The themes raised by medical professionals are quite similar in that they focus on “practical,” easy to understand and use information and resources. For instance, one notes:
"I think that websites such as REMM that are vetted by experts and provide rapid access to what you need to know in order to manage a certain event are terrific. It would be ideal if there were similar one-stop-shopping sites for other threats. They would need a point person or two to communicate with experts to update the latest information and delete outdated recommendations."
A second medical professional wants “best practices with summaries if I wanted to know what the best way to handle an event is.” Another medical professional wants:
A database with Disaster related instruments:
Pre Disaster HVA (Hazard Vulnerability Assessments) instruments.
Psychosocial Assessment tools
Post Disaster Response Assessment instruments.
A database with National/State/City protocols and intervention plans
A data repository with National/State/City disaster drill data
A centralized data repository with raw data published or research in progress.
A variation on this theme of need for practical information is contributed by a librarian, who says, “I would like to see more disaster planning and recovery information in Go Local. NLM could input national resources and local projects could input regional data.” An academic researcher states, “An all-hazard core Emergency Operations Plan (EOP) template for public health is missing.” Another researcher states, “The main problem for me is finding useful, real data on real-life emergency situations.”
In other words, the kinds of resources needed but not available now deal not with published literature, but with information, particularly about procedures and tools to support these procedures, that must be contributed, gathered, and vetted by peers who are actually on the “front lines” of emergencies, rather than by medical researchers. An international participant refers to this as “how to access the “grey” (unpublished) literature. It often contains the most up-to date and most relevant content.” If one uses “literature” to include the forms and procedures reports, the operations plans, the databases of personnel and other resources, and the “best practices” and case reports mentioned above, “grey literature” summarizes what is missing now.
Specific examples were then requested as follows:
3.b. Can you give one or two specific
examples of emergency situations or preparedness phases in which information
was needed but was difficult to obtain?
Two practitioners referred to missing information after 9-11. One described people who had been evacuated from their apartments hanging around hospital emergency rooms, because they did not know where else to go, and the personnel at the emergency rooms had no suggestions for them: “The need that I know of for health services professionals to understand the needs of the patient for broader help, for human services… what if they are being discharged and they have no home to go to?" He also stated that more generally, “every disaster large and small needs a complete and accurate guide as to where you, in this disaster, can get help and information you need,” specific to that disaster and that location. Online templates and related information could be provided to help to put together that information for any specific disaster. The second referred to wading through inches of ash two days later and thinking it was probably toxic, that people should have respirators on, but nobody had issued bulletins about this.
A librarian who worked with Katrina victims noted,
“Following evacuation of
In other words, what is missing in specific situations is up to date information and action advice about that specific emergency and locale. One practitioner states, “In the early phases of an event when one is totally dependent on media reports, the situation is so fluid that any information is either wrong, or out-of-date by the time you get it. Need to improve rapid assessment of needs (data for decision making, actionable threat awareness).” An expert in biological terrorism echoes this sentiment: “A confirmed biological event at any major transportation facility requires access to real time information in order to assess the public health risk and start the recovery process.”
Question 4: Organizing Information, Knowledge or Wisdom
4.a. What sort of methods or methodologies
(e.g. specific search engines, trusted sites, organizations, other peer
recommendations, email lists, filters, indexes, etc) do you use now to find
useful material and/or to avoid information overload?
Clearly information overload is a problem faced by just about everyone in this field. As one international contributor puts it, “Just as it is important to be able to obtain information; [it] must be relevant. This emphasizes the need for …"peer-reviewed materials that do not necessarily have to be present in a journal form (peer-reviewed web sites may do fine e.g.)"
This results in an extreme range of tactics for coping:
- Restrict inputs to only a few sources.
- Stick to only material which has been vetted by others that are trusted in the area of emergency preparedness and management.
- Seek push type sources with good filters on what is sent out.
- Seek contact with individuals based upon their experience and background in the area
- Rely on grass roots (free) type sources, people in the same area acting as individual "gatekeepers" or as a "team." Providing Web based information or as active participants in useful message list servers.
- Seeking process model structures as a way to get organized and well classified information (single index items inadequate)
- Attempts to develop morphological structures to classify data by the underlying fundamental dimensions.
- Seeking up to date information that is clearly defined in that manner
- Seeking specifics such as after action reports, reports of best practices, specific plans
We have drawn a number of examples in Appendix A of this report that include some grassroots examples. While there have been some of these efforts in existence since 9/11 it seems to have mushroomed since Katrina and some of the major international disasters.
While many are coping with the problem and have established a workable approach for their situation, it is clear they are suffering the stress produced by the "opportunity costs" they are encountering. There is a general feeling that there is better information out there but they are not aware of where the specific things they need or should need are or what they are and how they can find them when their responsibilities and duties leave them little extra time. Can one do better plans, improve training, and choose better actions or decisions based upon some information or wisdom that is somewhere but which they have not accessed?
Trust in sources and things like the lack of cooperation or collaboration between different organizations or levels of government is also an underlying problem. When organizations do not feel, for whatever reason, they can expose their mistakes and seek to eliminate them through integrated efforts then there is no way the improvements can be made to create an HRO (High Reliability Organization) among all the diverse groups that must be involved in the integrated planning, training, responsiveness, or recovery processes of an emergency or disaster situation.
A lot of different sources are attempting to become the one source that everyone should go to for disaster information, and this is not a worthy goal given the diversity of topics and problems that are involved. What it is doing is making it more difficult for many people to solve their information overload problem and/or raising opportunity costs to them personally and emotionally.
4.b. Are there ways or methods you would like
to see material in this area organized, indexed, clustered, processed, and/or
filtered that would make it easier for you or others to recognize that
something new might be of use to you or others in this area? Or, what would you like to see done to
cut down the time to find useful new material?
These two quotes summarize it well for the practitioner:
"Unfortunately I have found that it takes somebody knowledgeable (me) to go through all the various resources and pull out what is useful. I also am a generalist in terms of interest in all things medical/public health, with a strong interest in everything else available in the homeland security field. Many, many, many organizations are trying to be the “be all and end all” of an information source and none are really succeeding at this point.
Using the SNS (Strategic National Stockpile of medical resources) list serve as an example, there are so many submissions that it is tempting to read none. Somehow they need to be categorized, and it needs to be possible to unsubscribe to portions of a list serve or to filter in what you would like to receive."
It is clear they feel the need for experts that are devoted to the information classification problem that goes beyond the abilities of a general reference librarian. It would seem to say that librarians need to develop systems where the expert-users can make recommendations on the quality and content of the items be covered if in fact one is going into the gray literature. Clearly a lot of what actual practitioners want is the gray literature. Even the professional vetted journal literature differs considerably in the relevance to a particular situation and this is important to many of those in positions of management or practitioner experts. Clearly there is no time to hunt down needed materials in the actual disaster phase.
"Basically, a "documentalist" who will retrieve only the relevant information on behalf of the users. Will also need an expert such as an epidemiologist to consolidate data from a variety of sources, formats etc... and most importantly to synthesize information."
There seems to be a feeling that in some ways too much guidance on what to do and not enough focused help is being generated on how to do it.
"Yes. Universities, Institutes and the Federal Government need to provide consulting services (often referred to as technical assistance) to Grant Awardees and other governmental and Private Sector Healthcare entities. We need less guidance and much more hands on assistance."
There are repeated assertions elsewhere that the official documents often have no common internal framework relevant to the emergency community and this makes it difficult in dealing even with the official material. Considering the wide range of agencies and contractors involved this has a ring of truth to it. However, in some areas, like dealing with emergencies like pandemics, we have not had much experience with it might be too soon to try to impose such standards.
Setting up a separate integrative portal for each type of disaster was suggested and might be a worthy goal if it truly allowed cooperation and collaboration among different vetted professionals and organizations in compiling and judging the quality of the material. Note that users seem to want a much more hands on collaboration for contributing and evaluating material.
"I would like to see more community-based approaches to material, particularly using social tagging to create a more grounded taxonomy – the one we currently have is heavily predefined by the Cluster system. An aggregator of academic publications that might be useful in disaster response, from a range of journals in different topic areas, would be very useful in helping the humanitarian community to access this expertise – at the moment; it’s just too difficult and costly for us to stay up on current research."
"You may wish to consider Google’s approach and/or folksonomies or tagging. There’s a couple of really fascinating videos on YouTube that talk about Web 2.0 and organizing information. One on the Information Revolution and the other on Web 2.0; both are by Michael Wesch. If you haven’t seen them, you should. Unfortunately, our IT security people have deemed both YouTube and Facebook to have no valid business purposes, so I can’t simply send you the URL."
From the examples we have collected via our participants it is clear the users are anxious to help one another as a community of practice and in the emergency field this trend is going to continue unless they are brought in as an active part of the formal systems that seek to support them. Once again, a lot of the examples in Section 5 and Appendix A are free and based upon efforts of unpaid volunteers.
Question 5: Current outstanding examples or missing materials on the Web
5.a. Are there any other specific medical,
health care, public health disaster plans or training materials or web based
resources that you consider outstanding examples of such material?
There is a “grab bag” of suggestions in this section, but many simply repeat sources already mentioned in question 3, such as CDC and REMM. However, there are several mentions of the need to use “new media” typical of Web 2.0, e.g.:
“Internet 2.0, Wiki, Blog, Forums, Social Networking, shared work spaces like Groove, use of cell phones to reach isolated, deep field populations (everyone on planet earth has a cell phone). Voxiva has taken the lead in the area of "Phones for Health" initiative with the Global GSM Alliance.” Two experts mention how good Wikipedia is.
Online training materials and courses are mentioned, as well as Wikipedia, as being very useful for volunteers (fire departments and other community service organizations) and for local communities that do not have the funds (or access) for more costly sources of material.
Question 5.b. asks:
What material not currently available on the Web would you like to see
there?
The diversity of responses is similar to that for the first part of question 5. Some specifics that seem notable include:
Vital baseline health data (e.g., potential health risks in countries) and other focused background information in advance of disasters (e.g., large scale population movements, forced migration) to minimize mortality and morbidity from preventable causes such as measles and diarrhea diseases. This will require the identification of potential risk areas around the world for disasters, vulnerable populations, mass population movements, and to target these countries for contingency planning and advance health information gathering.
Easy to find medical management for Chemical terrorism.
Specific compilations of local "best practices," actual plans for organizations such as hospitals and community service organizations, schools, local agencies so that practitioners can compare and evolve improvements in these areas relevant to their localities.
More online training for health related problems in disasters, aimed at potential first responders and others likely to be on site.
A librarian would like “Local response efforts (list of shelters, first responders, etc.) in the event of a major or even minor disaster. This is where I see a major role for Go Local.”
Question 6: Roles of Libraries, Librarians, and Information Specialists
Question: What are
the current or potential roles and/or services for Libraries, Librarians,
and/or Information Specialists in any phase of the Emergency Preparedness and
Response process? Are there other
particular services a local or specialized library should or could provide?
Among the suggestions are:
- Creating and maintaining a taxonomy for my field would be a welcome contribution from the Library Sciences, so that as the body of knowledge and literature grows, it is usefully archived.
- A major activity would be to serve as a local, State, regional, national and international clearinghouse of knowledge concerning all of these different aspects of disasters.
- Foster the transfer of knowledge among the different stakeholders, and policy makers in order to improve society's resilience to disasters and other emergencies.
- Libraries
must be equipped with real-time Emergency Telemedicine Networks.
- A crucial need its just to keep track of plans and supporting documentation
- Continuing to work with specialists to identify high-quality information and developing easy-to-use methods of delivering specific content.
- Produce
something like the
- Participation in call centers taking questions from public – helping shape responses into understandable FAQs and making sure people can find them.
- They could be requested to assist in mining, aggregating and compiling information so that existing information can be easily analyzed by public health decision-makers and provide context for their decisions.
- It would be very useful to create an international network that allowed librarians and archivists in developed countries (where most of the resources are located) to share expertise with those in developing countries.
Question 7: Extreme Events
Question: If you had to
consider an “extreme” but possible event (e.g. a pandemic, another Katrina, or
a large earthquake) would this add additional information requirements relevant
to any of the other questions on this survey?
One emergency practitioner gave a very complete set of special requirements for such crisis situations, including:
Particularly, "human generated" events (Chemical, blast, technological, transportation, radiological, nuclear emergencies etc) would require very specialized information requirements… including baseline health indices, diseases, in-country capacity such as the following:
a. Health data such as:
-epidemic risks
-incidence and prevalence of communicable diseases and vaccination coverage
-nutritional status
-country health profiles and other public health information such as status of local health facilities and the availability of other material resources
b. Basic ethnographic data on populations at risk of adverse health consequences from disasters. This could include some medical anthropology data so that health programs and interventions could be made more culturally acceptable.
c. Database of in-country NGOs, UN agencies, and their resources (this may include many development organizations, but many of these may also have emergency relief capabilities). Ideally, this would include list of key individuals and points of contact information but such information may change too often to be readily kept up to date.
d. Description of the country's disaster plan, if any. Specifically, this would include what ministries, etc. are responsible for preparing for and responding to emergencies.
e. Organization of health professional training in the country of origin.
f. Logistics: warehouse capacity, availability/price of gas/diesel, air/road access, telecommunications (e.g., availability of landline phones, mobile phone cells, electricity), etc.
g. Local and regional laboratory capabilities for identification of causative organisms and antibiotic sensitivity testing, drug resistance (e.g., to chloroquine) and nearest reference labs for cholera, shigella, etc. If not available in-country, should note guidelines for transport.
h. In-country production capacity for and availability of drugs, jerry cans, cooking kits, etc.
i. In-country availability of food stocks
This type of information simply is not available now. Much of it is not “medical” per se but all of it relates to public health issues after a massive disaster.
There are systems design implications of the fact that many large scale events, especially those that may be caused by terrorists, are not only unpredictable, but often “unimaginable” ahead of time. Thus, as another emergency practitioner notes, “I think it is important to recognize that the future is uncertain and hard to predict and that systems need to build that are flexible to the needs of rapid specialized information delivery.” In addition, the physical communications infrastructure for delivery of this fast breaking information must be thought about: “What level of web traffic can the best, trusted sites handle? If they can’t handle the load, where do they redirect? If we lose Internet, how to disseminate information? If schools are closed, librarians with families are not available to fulfill their roles, unless library planning incorporates school planning. Is there hazard pay for staying in an area deemed at risk?”
Question 8: Your critical topic areas
In terms of creating
an index (general ontology) out of a sample document database that can then be
used to automatically classify new information as it occurs, what would you
want included in such a database and what specific topic areas would you want
to see in the resulting index or ontology?
This is a question that may be very difficult to answer based upon cognitive differences. Those who are able to deal with abstraction usually have a better chance of conceptualizing a more complete specification of terms as opposed to those who deal better with data specifics and are very oriented to specifics. Both types of problem solving processes are represented.
We had a wide range of responses from one single term to thirty eight terms in a two level hierarchy. A significant variety of types of emergencies are represented. There is recognition that the dimension of terrorism introduces the possibility of risks that create medical problems that are the common ones that medical and health care professionals may be familiar with in a given locality. Hence the need, as expressed, elsewhere for very selective retrieval capabilities. The need for great precision in finding material is quite clear in an emergency situation. Here is an example of one of the more detailed lists suggested as one respondent’s areas of concern:
- General Concepts
- Basic physics of disasters
- Triage
- Pediatric considerations
- Infectious diseases
- Pharmaceuticals
- Critical Incident Stress
- Complex Humanitarian Emergencies
- Disaster Response Planning and Coordination
- Disaster planning
- Public health in disasters
- Urban Search and Rescue
- Federal
Disaster agencies and response (CDC, DMAT,
- State and local disaster agencies and response
- Communication and information technology Tools
- Managing disasters in austere environments (including Wilderness EMS)
- International level response, planning & coordination
- Incident Command System
- Disaster Drills
- Natural Disasters
- General information
- Infectious disease epidemics / pandemics
- General info
- Planning / response / coordination
- Local / state / federal level
- Industrial, Technologic and Transportation Disasters
- Radiation accidents
- Hazmat-related disasters
- Mass gatherings
- Maritime disasters
- Air crash disasters
- Fires and mass burn care
- Internal hospital-related disasters
- Conflict-Related Disasters
- Conventional terrorist bombings
- Nuclear detonations
- Intentional chemical disasters
- Biologic weapon agents – including vaccination information
- Tactical
- Mass Shooting
- Education, Training, and Research
- Education and training
- Research
- Personal accounts from deployments
- Disaster Medicine Resources / References
Over time changes have occurred and every large scale disaster introduces new problems we did not think about before, with Katrina and 911 being prime examples. The emergency of the pandemic as a new risk requires not only new terms to represent new problems to be addressed but also the necessity of integration of other dimensions of concern over extended periods of time. All the supporting infrastructure and logistic maintenance of normal consumable resources cannot be separated from the medical situation. This is evident for a short time scale of weeks in Katrina but in a true pandemic this might be years, both for the disaster phase and the recovery phase of an emergency.
This need for dynamic changes in the indexing of information is evident in the following quote from the contributions:
" Whatever ontology is created by librarians is unlikely to be used by contemporary practitioners. Authors won’t use it because they are forced to fit their work into categories that never quite fit. Searchers won’t use it because the term that they are using isn’t the same one that the author used. One only has to observe that of all the ontologies created by librarians to date, why are none of them used by any of the popular Web search engines???"
The above change in terms due to a better understanding over the long term is further complicated by the change in the required information over the phases of emergency preparedness and management.
"Perhaps classified in terms of information useful before, during, and after a disaster. That which is useful for education, clinical care, research, recovery, reconstruction etc."
Whatever the process there has to be allowance for change and knowledge structures that can evolve to meet changing needs. In terms of current technologies this means some combination of automation and direct involvement of the expert users themselves to be the source of new classification requirements.
Question 9: International Considerations
Question: The
national Library of Medicine has an important role in aiding other countries in
the accumulation and dissemination of medical information and knowledge.
9.a. What specific contributions in the above
disaster information areas might be important for NLM to provide internationally?
One international contributor notes, “NLM has to project itself as an International Repository for Disaster Management and allow the United Nations to foster a program of affiliation with all Member States.”
Cultural and language diversity were noted by several contributors, e.g., “I think there would need to be special efforts to include information that is useful to developing countries that doesn’t rely on high tech solutions that we have in developed countries. A lot of care would also be needed to make it culturally appropriate. Last, but in many ways first, it would need to entail a dialogue with stakeholders to see what – if anything – they would like from such a resource.”
Another suggested, “I think it would be very useful to create an international network that allowed librarians and archivists in developed countries (where most of the resources are located) to share expertise with those in developing countries.”
And one practitioner gives a very detailed set of requirements, noting that “Normally, when a disaster strikes, we frantically call various international organizations such as WHO, UNICEF, IFRC, ICRC, OFDA, NGOs, and contacts in various other organizations to obtain decision support information… One stop shopping approach (would) both enable and save time.
If NLM can more or less provide such a service, international disaster relief may become more effective because we would be able to achieve the following:
(a) - more targeted intervention instead of the present stereotypical cookbook approach
(b) - effective stockpiling
(c) - geographical pre-positioning
(d) - improved targeting of rapid health assessments
(e) - briefing or orientation packages for staff deployed to the field
(f) - knowledge of key players, roles and coverage for improved operational coordination
(g) - better strategic decision making by senior managers
(h) - provide an entry point for relevant expertise at NIH, CDC, HHS, FEMA and other organizations where necessary
By facilitating more efficient targeting of response, NLM will contribute to more efficient use of shrinking funds for international humanitarian assistance.”
9.b. What contributions from other countries
could be made to NLM in the disaster information area? This could include important information
sources in other countries not traditionally used in the
As one contributor states,
There is a lot of material in other countries – local contingency plans, lessons learned, case studies, etc – but it is difficult to access as many of these documents are either not in digital form or are held locally. By providing an example of open document collection, NLM could work with other institutions in these countries to encourage and help them to share more widely, thus building recognition for their contributions. “Best practices and “lessons learned” documents from the international community for emergency events would be a big boon to the entire global emergency management community.”
Specific suggestions include:
Analysis of data collected by UN (WHO, OCHA) on medical
impacts of disasters, public health issues etc. World Bank and UN have studied this more
than the
One of the great things developing countries could teach us is how to respond if all our high tech solutions (internet, advanced medical technology) fail such as if there were large blackouts or in events like a large earthquake, etc.
Best practices and “lessons learned” documents from the international community for emergency events would be a big boon to the entire global emergency management community.
Question 12: NLM experience (if not mentioned in prior answers)
Question: Have you
ever used MEDLINE/PubMed or any other NLM system (e.g. WISER, REMM, TOXNET) to
find information related to Emergency Preparedness or Management? If so characterize your experience and
reaction.
Many of the contributors had great praise for NLM current services, e.g.:
“All of them. They’re terrific. The gold standard.”
On the other hand, especially among emergency rather than medical practitioners, one sees comments such as “I know most of them exist but have not used them more than just looking once or twice.”
This is probably because the current databases are not really oriented towards “gray literature” of practical use in emergency response, e.g., “I use MEDLINE very often but predominantly to find scientific or clinical articles to supplement my work. There is very little information related to public health management or public health emergency management. My experience has been similar with PubMed. “
The responses to the “other” question at the end are so scattered that finding major themes is not possible. However, we close with a quote from question 14 on “Anything we left out?”
“It would be wonderful if the NLM were to be asked to join
DHS as a full Partner in preparing
It is clear there is a general feeling of information overload among those in this field and the possibilities of improved library oriented professional help would be welcome.
Question 13: Anything we left out
Please add any other
information or comments that you think we should have asked for or any
questions that should be added to the response guide.
This turned out to mostly attract major issues which at least indirectly do lead to problems in the information process necessary to carry out various phases of emergency preparedness and management. These in summary form are:
Lack of communication and information exchange between the medical and the community service operations in emergencies and in particular after the immediate response is over.
Not clear from the legislation and policies what the goals and responsibilities are of the federal, state, and local agencies with respect to degree of aid and recovery of the public.
Defining roles: beneficiaries, information suppliers, information users, target audience, stakeholders, investors, etc.
Improved cooperation and coordination among various federal agencies.
Better working definitions of various concepts such as scope of an emergency, coherent conceptual models, degree of quality improvement, measures of the threat.
More explicit treatment of ethical issues, beginning with the planning process.
5. Examples of Information Overload Mitigation and other relevant activities
In the process of obtaining this material we encountered from the respondents and from our activities in searching for respondents many examples of either the documentation of the plethora of sources, that creates overload, or efforts to create aids for the reduction of information overload among practitioners.
Many of these can be considered as "grass roots" efforts in that a single individual or a small team of individuals concerned with some area of emergency management and response banned together to supply an information service. Many of those involved are practitioners in the field and the problems they had over the years in sorting out relevant information from the volume of information being generated led them to track and document their success as well as making it available to other practitioners.
In some cases these are carried out by individuals who are consultants, organizations, and/or consulting firms. But we only consider situations that were free to practitioners and largely publicly available on the Web (with one exception).
The examples, which are described, are included in appendix A to this report. They are:
- A collection of data on the
distribution of relevant information in journals
- Relevant websites collected,
categorized and shared by one individual practitioner with the rest of the
community.
- An example of a quality and useful
document in the gray literature not indexed or available on the Web.
- An international Mental Health Website
from
- Interstate Chemical Terrorism
Workgroup and the InfoMatrix which structures hazardous material
information relevant for practitioners.
- Communities of Practice: Big Medicine, ISCRAM, All-Hands,
and related Individual efforts
- An individual respondent's answers to
this NLM inquiry available on the Web
- Worldwide online courses for medical
professionals handling trauma: ITLS
6. Conclusions and Observations: UNMET NEEDS
There are numerous observations made throughout the document both in the summaries and in the detailed compilations of the viewpoints of the respondents, who are emergency response practitioners and experts, broadly defined. Here we first restate and summarize what seem to be the most important unmet needs related to medically-related emergency preparedness and response, affecting the ultimate choice of options for NLM's efforts in this area. Then we also provide a list of some summarized observations from the data.
TOP UNMET NEEDS AND DESIRES
- Resources for coping with information overload, broadly defined, due to the plethora of types and sources of information. As one of our international experts put it, “Just as it is important to be able to obtain information; [it] must be relevant. This emphasizes the need for… peer-reviewed materials that do not necessarily have to be present in a journal form (e.g., peer-reviewed web sites may do fine).”
One aspect of the problem is the need and desire to be able to have organized, peer-reviewed access to some of the “gray literature,” such as lessons learned, best practices, examples of plans and procedures for emergency response for different types of situations. A recommender system for expert communities (communities of practice) is one possible approach to this problem.
Experts in specific areas expressed the need to be able to nominate and evaluate specific gray literature documents and view the collective results of this for their given peer group. In addition, they want to be able to link this material to tags appropriate for their specialty group. One can expect software to do this to evolve in the growing effort to provide tools for communities of practice and a growing effort internationally to provide open source software for international humanitarian efforts.
Another aspect is the frequently expressed need for more complete indexing of terms for health-related emergency response information resources. Useful indexes would cover all kinds of health-related emergencies and also be tied to region-specific information. They would be usable by emergency planners and responders as well as by physicians.
- An expansion in comprehensive “one stop” information resources for additional types of health-related emergency threats, specifically, expanding the REMM approach to other specialized areas. (The Radiation Event Medical Management site covers the diagnosis and treatment of radiation injuries during mass casualty radiological or nuclear events). There are many other classes of emergency events for which both non-specialist physicians and first responders might need a similar well organized compendium, e.g., biological events, chemical events, mass injuries from large scale natural disasters (e.g., hurricanes, earthquakes, floods) or infrastructure failures.
- Online availability of templates and guidelines for concisely gathering and providing all of the information that will be needed in a locale or community when it is struck by disaster.
- Expansion in the roles of local libraries and of reference librarians, through “Go Local” type efforts, that provide local information (e.g., organizations, resources, maps of infrastructure) as well as expertise to help local emergency planners and responders to find the most relevant information currently (online and in print) that applies to a situation they are facing. (This would include plans for keeping libraries open in emergencies, if they are to serve as information resources then.)
- Collections of practitioner documents in specific areas such as plans, best practices, training materials, and requirements and design studies for support systems of all sorts. Many localities do not have adequate resources to pay for these and national level documents do not deal adequately with local situations. Having a compilation to compare and evolve current plans, training, and other preparedness activities would be quite valuable.
We also offer the following observations to keep in mind in thinking about services that could be provided by DIMRC, each arising from several mentions, but not meant to be rank ordered:
- Currently literature in this area is very scattered, especially the gray literature.
- Many types of gray literature are considered critical to practitioners and some of them are not collected and organized in any systematic library science approach.
- Static indexes are not going satisfy the users at the practitioner level and even the academic level because the current the field is evolving and changing.
- Users have turned to social networks to help alleviate information overload and are attracted to services that support the underlying social networks.
- Users want to have control over their abilities to filter and organize their material.
- Users also want more professional help aiding their information seeking processes.
- There are too many sources competing for being” the source" and this lack of organizational cooperation is a major challenge to overcome.
- A professional library could be the logical mediator between organizations.
- Grassroots based services worldwide are undergoing rapid development.
- Collaboration capabilities (e.g., social recommender systems) are expected by practitioners and they have begun to gravitate to systems that provide them.
- A form of recommender system on gray literature documents recommended by users could be explored as an appropriate method to allow user involvement.
- An approach to users contributing and evaluating "best practices" is another obvious recommender type of approach if the system can integrate local factors for the individual user.
- Practitioners have adopted a wide variety of coping mechanisms for dealing with information overload, and while sufficient to do their job in many cases, it is not always satisfying to those who feel there might be better solutions.
- Structuring and visualization approaches to provide quick access to complex information should receive considerable attention to service the practitioner community.
- AI approaches can also be very useful if the users have control over setting what are sometimes very unique needs and requirements or training the AI in a feedback process.
- Collaborative tagging was mentioned a number of times by the respondents and seems to be one example of the desire to have involvement in the process of tailoring the systems serving them.
It should be noted that many of the above concerns and concepts apply to emergency preparedness and management areas in general and not only to the topics of medical and public health considerations. It should also be obvious that in some aspects of the problem the emergency medical and public health areas cannot be separate from other areas of concern such as utilities, infrastructure, transportation, logistics, and coordination among many different agencies and organizations.
Appendix A
Examples of Information Overload Mitigation Activities
1. Example of relevant data on paper distribution in journals
One of our respondents, Marv Birnbaum, Professor at the University of Wisconsin, provided us with
a set of slides he produced for a presentation at WHO (World Health
Orientation, Feb. 07) which we have incorporated with his permission. They use a collection of journal
articles dealing with some recent disaster events.
The
results represent supporting evidence for two important points that support
empirically many of the views of the respondents to this study.
- Even when the literature is focused on only journals there is a tremendous scattering of the literature on a single event over many different sources, topics, and journals.
- The health and medical areas interact with a great many other areas of concern in an emergency so that it is hard to treat many of the areas in isolation from one another.
The second point arises from the diversity of topics of the journals involved and the final slide which reflects the relationship of health to:
Health
- A "state of Being"
- An ideal value
- Survival, welfare and dignity
Health Determinants
- Population, environment, economy, education, security, food, water, habitat, health services, support systems and lifelines,
Health Sector
- The part of economy, institutions and society that deals with the demand for health (i.e. services, norms, production and distribution of drugs, etc)
Health Services
- The resources and processes dedicated to activities that are intended to improve health (i.e. service delivery, norms and standards setting)
Medical care
- The resources and processes dedicated to the delivery of preventive and curative medical services (i.e. service delivery)
While in the immediate response to a disaster medical care
is the highest priority, we often forget why many common disasters in the
Y axis Percent of Sources (journals)
Y axis: number identified
Y axis: Percent of journals
2. Relevant websites collected by one individual.
One of the practitioners who responded, Gregory Banner of DHHS, has been collecting useful websites for many years and his list of sites is on the Web and has been conveyed to other emergency managers through a number of shared message lists.
http://www.ynhhs.org/emergency/us_dhhs_web_sites.pdf
WMD,
Emergency Management and Medical Web Sites
1.
The following is intended to provide a comprehensive list of internet sites of
use for emergency planning and in particular Weapons of Mass Destruction (WMD)
and medical emergency planning. To
be useful as a working document, the listing is divided into the following
categories
Organizations
Federal Agencies
(Includes non-US national-level offices)
International
(International Agencies)
Local Emergency
Management/BT/Health/WMD web sites
Private, Non-Profit,
Academic Organizations, Professional Societies
•
Disease Monitoring Systems
•
Web Link Compendiums, Glossaries, Search Engines and other Resource
Listings
•
References
Agricultural, Animal,
Food, Water Issues
Business/Facility/School/Installation
Information
Community/Local
Planning
Decontamination
Diseases/Conditions/Agents/Treatment/Surveillance
Systems
Dispensing Functions,
Strategic National Stockpile, Pharmaceutical
and Other systems.
Equipment and Personal
Protective Equipment,
Federal Plans and
Guidance, Laws, Regulations, Public Health Planning
and Guidance
First responder
guides/procedures
Hospital & Health
Facilities
Incident Command System
and
Individual/Family/Public
Guides & Info, Volunteers
Information
Management/Public Affairs/Alert Systems
Laboratories
Legal and Law
Enforcement Issues, Intelligence Documents
Logistics
Mental Health Issues
Mortuary Affairs
Special Populations
Transportation
Miscellaneous
•
Training/Seminars/Classes/Conferences
2.
There is an incredible amount of information available through the
internet. As an introduction to
understanding the complexity of all of the federal offices involved in WMD, go
to the organizational chart at http://cns.miis.edu/research/cbw/domestic.htm#wmdchart
3.
To keep this list at a manageable level, some information is specifically
omitted. There is a separate
document which lists on line periodicals and list servers. This list is available from the author
below, upon request.
4.
PLEASE NOTE - This list is constantly being updated. To contact the author for the latest
version, or to provide additional information, send an email to: gregory.banner@hhs.gov
Note that this collection of websites is 73 pages long and represents around 1300 separate links within the above categories. Every reader should look at the link in item 2 above giving the chart of all the federal offices involved if they are not familiar with that situation. It does illustrate part of the problem very well in terms the integration across different organizations.
The above is considered a useful reference list by many practitioners and one should note that it lacks any abstract giving a description of each site that would probably enhance its value. However, the sites are clustered and categorized by terms relevant to practitioners.
3. A quality document in the gray literature
In messages with an expected participant we were sent the following report:
Public
Health Preparedness Decision Support System
Geoffrey
Hoare, PhD and Jeffrey A. Nield, MA
Alachua
County Health Department,
Public
Health Preparedness Decision Support System: Pilot Project Report
PHP-DSS_Report_v90.doc,
Version 9.0, Printed:
EXECUTIVE
SUMMARY
Timely
access to current health and medical data is a critical element of disaster
preparedness and response. A clear
understanding of resource availability across all types of health and medical
facilities and response assets, improves situational awareness and, hence,
decision making. A decision support
system, or DSS, is a database with specialized communications, analysis and
reporting functions to more effectively manage complex information. Several health and medical capacity DSSs
are employed in Florida, yet no one system captures the breadth of information
needed by the Health and Medical Emergency Support Function (ESF - 8), at the
county, region or State levels.
This
report describes a research project that piloted an integrated health and
medical Decision Support System for
This is a document of 105 pages and which would never appear in a journal with the same level of detail that would be necessary to aid other localities to undertake their own efforts without repeating a great deal of the investigative effort that has already been accomplished by the authors. This is an excellent example of what appears to be a quality report that would be useful to others but only if they can easily find out it exists and where to get it. While documents produced at the federal level are easier to find those produced locally are much harder to detect. There are many instances where materials generated by a locality are more relevant to plans and the design of processes for other localities than what comes from the top down. This particular document is not on the Web nor could we find it referenced on the Web via Google.
A copy of the document has been forwarded to NLM for examination as a document in support of this report. It is an excellent attempt to integrate all the medical information and data in a given locality for use in any phase of emergency preparedness and represents a very detailed requirements study. This is only the first in what is supposed to be a series of efforts leading to a working system.
The author has submitted a practitioner’s paper to the ISCRAM08 meeting (http://iscram.org) and those free proceedings on the Web after May of this year should allow those interested to request the full report via the author or the organization that sponsored it.
The need to get useful gray literature involving plans, requirements, best practices, training materials, etc is expressed by many of the participants seeking better access to gray literature materials such as this particular document.
4. An international Mental
Health Website from Sweden
This website, in seven languages, is a very comprehensive collection of mental health information for the public. It is developed and maintained by both psychologists and psychiatrists. It includes online consultation with professionals, discussion forums organized around a particular problem area, and extensive regular updates from all around the world, all vetted by Swedish professionals.
http://web4health.info
The above site is for public access to expert vetted information on all forms of mental health problems.
Since 2004 they have started to add subjects of trauma having to with those who have lived through a disaster. In the extensive QUICK Title Index (which indexes all words in each title) are the following entries:
Child Molestation Trauma
Psychological Help for Trauma
Victims of Disasters, for example Tsunami Victims
Symptoms of Post Traumatic
Stress Disorders (PTSD), Effects of Violence
How To Treat
Anorexia Nervosa
Preventing and Treating
Gambling Addiction
While there is only one entry for disaster victims at this point, it might be more productive to add more entries to this Swedish system than to develop a new web site about trauma.
One might also consider the need for a similar system that handled public first aid information for the type of injuries or difficulties that are more common in disasters of various types than are present in the typical first aid manual.
The following message is from one of the principals involved in the development, design, and evolution of this system.
Jacob Palme
<jpalme@dsv.su.se>
To: turoff@njit.edu
If you have any
experts who want to develop informational texts for the public about disaster
victim issues, we can publish their texts on our web site. That way, they can probably get more
people to read what they write, since we are a large web site with lots of
visitors (650,000 visitors, two million pages downloads per month).
All our texts are
written by, or approved by, medical experts in the area of psychiatry and
psychology.
Jacob Palma
<jpalme@dsv.su.se> (
for more info see URL:
http://www.dsv.su.se/jpalme/
Note that in the responses there are a number of other international medical websites and organizations that are considered valuable sources of information. Considering cooperation and collaboration with some of these entities might be a very productive approach.
5. Interstate Chemical Terrorism Workgroup and the InfoMatrix
This organization has integrated all the web based sites that have significant information about hazardous and toxic material problems into one information structure based upon an excel matrix (ICTWInfoMatrix). This is a volunteer group who works very hard to update and improve the content on a regular basis. The first column is the name of the organization providing the information and the second is a link to the information. The third column is a very brief paragraph about the site.
The other columns are the following:
Toxicology
Exposure Guidelines & Standards
Chem / Phys Properties Environmental Fate / Transport
Emergency Response
PPE
Decon
Acute hazards
signs, symptoms
First aid / Emergency Treatment
Med Trtmt Guides - Health Profs
Public FAQs
Other languages
Planning & Preparedness
The only information in these columns is an X indicating the site represented by the row has useful relevant information under that column so that the user knows that link is useful.
The row entries are divided into clusters by the following classification systems
I. Emergency Response
I.A Critical Phone Numbers
I.B First Responder Databases
I.C Decontamination
I.D Emergency Exposure Guidelines
I.E. Field Detection (also See Laboratory, II.D
I.F Personal Protective Equipment
II. Technical Support
II.A Chemical Fact sheets
II.B. Chemistry & Toxicology
II.C. Clinical/Medical
II.D. Hazard & Vulnerability Assessment
II.E Laboratory (also see Field Detection, 1.E)
II.F Public & Community Resources
II.G. Veterinary, Pets
Currently there are 105 different sites documented in this single matrix structure. Apparently this has become a common tool for professionals in this area and it was developed by the users themselves.
This type of approach represents the creation of an appropriate information structure as a multidimensional morphology appropriate to the topic area. It allows practitioners in an emergency to locate very quickly exactly what they need.
Erik Janus is responsible for the creation of the first version of the matrix and he and some of the others involved have submitted a practitioner’s paper to ISCRAM08 (http://iscram.org). Sharon Lee is the ICTW facilitator and the contact for further information.
Statement by:
California Department of
Public Health
Environmental Health
Investigations Branch
Many of us working in
state and local agencies have been urged to develop information on the role of
public health in the event of chemical terrorism, and once the role is defined,
to develop relevant materials. In
an effort to define our role and to share knowledge, materials and resources,
representatives from state, local, and federal agencies have formed this
workgroup.
The ICTW, formed in
2002, currently includes members from nearly all states and
6. Communities of Practice and Individuals: Big Medicine, ISCRAM, All-Hands, and Individual efforts
There is a rapidly increasing formation on the Web of Communities of Practice, which are loosely defined as professionals or knowledgeable people concerned with the same topic who gather, discuss, and disseminate information among themselves and often to larger audiences if they choose to be open to the public.
They are characterized by not only creating websites for dissemination but also by employing some form of collaborative software that allows meaningful complex discussion to take place. We have chosen a few examples from what appear to be very popular and respected examples in the emergency practitioner community. While only the first one is focused on medical and health topics the others all have these topics as part of their concerns.
Big
Medicine
This network gathers and disseminates information for emergency practitioners in the health and medical field. It is operated by a team of volunteers comprised of both practitioners and consultants. The director of the effort is Hal Newman, one of our respondents who also contributed a quality list of documented international websites that is in the appendix to this report. The site may be found at:
http://www.bigmedicine.ca/index.htm
The above is a news publishing site and it also has a collaborative site:
http://bigmedicine.collectivex.com/main/summary
Which has discussion forums and other features to allow the members to network and exchange information.
This effort might best be characterized as a "community of practice" for practitioners in emergency preparedness and management concerned with the medical and health aspects.
ISCRAM
(Information Systems for Crisis Response and Management)
In that regard Big Medicine is somewhat similar to ISCRAM (Information Systems for Crisis Response and Management, http://iscram.org ). It was formed in 2004 for professionals interested in the problems of developing better information systems in this area. Both online communities were formed from grassroots efforts.
ISCRAM started as a workshop in 2004 in
This is not a new phenomenon in that every professional group taking on a new professional area starts out as what used to be called an "invisible college" that did not follow established paradigms and tended to not have a well established publications system. The way literature and information is scattered in this field is further evidence of the situation with respect to emergency preparedness and management.
All
Hands Information Portal
This news collection and distribution site allows practitioners to contribute, utilizes volunteers, and is supported by a consultant firm made up of practitioners. It has an editor that reviews contributions before they are entered and insures they get properly categorized into the topic areas. The website is
In the words of current facilitator:
Steve Davis
<steve@all-hands.net>
to turoff@njit.edu,
date
subject RE: inquiry on NLM
I agree that
information overload is an issue.
The All Hands Community -www.All-Hands.net was designed to help but the
proliferation is too much and our search tools too primitive. My list does not send attachments but
feel free to post to the site or do an e-mail to the group on this.
Also, All Hands has a
blog and forum feature if you are interested in using either of those.
Thanks,
Steve Davis
7. An individual respondent answers on the Web
It does not have to be a community but actually as we have seen single individuals in the community can set up a website to help others in the community. That was illustrated by the long term effort on the extensive list of websites in Banner's prior example. Here is one created as part of this study which is now public.
One of our respondents developed a web site for his answers to this inquiry. His statements have been incorporated into the compilation of all the responses contained in the appendix. However, the site prepared by Dr. Eric Noji contains a number of valuable links to illustrate the points he wished to make; therefore we are including a link here to the site and recommend it as a useful list of other sites.
http://veritas-invictus.org/NLM_Survey.aspx
The respondent provided permission to make this public.
There are a large number of individuals who have established websites and in particularly blogs or Wiki pages concerned with topics in these areas. Trying to identify them all would be beyond the effort here. However some of them do have a significant following as they exhibit more specificity into various subtopics, expressing a highly specialized interest that attracts a small but committed group. The small group working on the hazardous substances, InfoMatrix, is clearly one such community.
8. World wide online courses for handling trauma: ITLS
This
The following is copied from the website:
About ITLS (http://itrauma.org
)
International Trauma
Life Support (ITLS) is a global organization dedicated to preventing death and
disability from trauma through education and emergency trauma care.
ITLS was founded in
the early 1980's as Basic Trauma Life Support. From its early roots as a local and
regional trauma education course for
Organization: ITLS
training programs are aimed at prehospital (or out-of-hospital) providers. Since its founding in 1982, over 330,000
EMS professionals have learned proven techniques endorsed by the
International Trauma
Standard: ITLS is accepted internationally as the standard training course for
prehospital trauma care, and is not only taught as a continuing education
course, but is also used as a textbook in many Paramedic, EMT, and first
responder training programs.
ITLS courses give the
student the knowledge and hands-on skills to take better care of trauma
patients. ITLS stresses rapid
assessment, appropriate intervention, and identification of immediate life
threats. The ITLS framework for
rapid, appropriate and effective trauma care is a global standard that works in
any situation.
ITLS courses combine
classroom learning and hands-on skills stations. They also challenge the student with
scenario assessment stations where learning is put to work in simulated trauma
situations. ITLS courses are
designed, managed and delivered by course directors, coordinators and
instructors experienced in EMS, prehospital care and the ITLS approach.
Each ITLS course
includes a comprehensive manual sent to the student in advance. The manual enhances learning experience
with in-depth content, photos, and illustrations. ITLS manuals are written by trauma care
experts and edited by the ITLS Editorial Board. After the course, the student can refer
to the manual as a valuable recap of what has been learned.
Appendix B
The Self Report Guide
STUDY FOR THE NATIONAL LIBRARY OF MEDICINE ON INFORMATION REQUIREMENTS
FOR EMERGENCY PREPAREDNESS AND RESPONSE
The overall goal of this study for the National Library of Medicine is to determine the most significant knowledge, information, and services they can incorporate into their development of a Disaster Information System available on the Web that can provide aid to practitioners about the medical aspects of Emergency Management and Preparedness. It is concerned with all the phases of EM&P: planning, threat analysis, mitigation, training, detection, response, and recovery.
We were asked to:
“assist NLM in determining the current information seeking behavior, existing preferred sources of information, and unmet information needs of people (researchers, practitioners, volunteers, non-profit organizations, local communities, and local, state, and federal government agencies) involved with emergency planning, preparedness and response to disasters with potential or actual medical and public health consequences.”
Given the range of backgrounds we are seeking input from, you should not feel you have to answer every question but should focus on those questions for which you have the most insight. Whenever possible, please provide “real examples” of information and materials or resources now used or needed but missing.
We will not quote any answer, viewpoint, or concept as being that of a specific person. If you approve below we will list you as one of the contributors to the report. However, to include your contribution we need to know the background information below for possible follow up. If you feel there is a particular viewpoint you wish to be associated with you may supply us separately a one page summary statement and we will include it in an appendix of such statements supplied to NLM, provided you have also returned this survey.
(Note: If you are completing this interview/survey guide on a computer in Word (.doc) you may add as much information as you wish below by increasing the space after a given question. If you have only seen a hard copy, message us to receive the text as an attachment to an email)
For a full statement of the related NLM goals see: Charting the Course for the 21st Century: NLM's Long Range Plan 2006-2016, recommendations 1.5, 1.6, 2.1, 2.2, pages 29-37. http://www.nlm.nih.gov/pubs/plan/lrpdocs.html
If you have any questions do not hesitate to contact us. Below is our email and websites
Starr Roxanne Hiltz, roxanne.hiltz@gmail.com http://is.njit.edu/hiltz
Murray Turoff, murray.turoff@gmail.com, http://is.njit.edu/turoff
Beginning of
Survey/Interview
1.a Background
information
Your Name:__________________________
Your email:_________________________
Your telephone:______________________
1.b Please list your current and most recent (last five years) positions and roles related to emergency preparedness, management, and/or response, including any specific emergencies in which you have assisted in some aspect of.
2. Current Sources
What sources do you currently consider as highly useful and important for medically-related emergency response missions including journals, organizations, websites, books, reports, plans, training materials, etc.? (Please give specific information, e.g., journal or newsletter name, URL for a web site, etc. If possible, also add a sentence about how and in what emergency situation this source has been used by you.)
3. Desired Sources
For medically-related emergency response missions: What useful resources, services, or types of information are now missing or difficult to access or use, that you would like to see more readily accessible to practitioners?
Can you give one or two specific examples of emergency situations in which information was needed but was difficult to obtain?
4. Organizing Information, Knowledge or
Wisdom
Are there ways or methods you would like to see material in this area organized, indexed, clustered, processed, and/or filtered that would make it easier for you or others to recognize that something new might well be of use to you or others in this area? Or, what would you like to see done to cut down the time to find useful new material?
5. Current outstanding examples
Are there any other specific medical, health care, public health disaster plans or training materials or web based resources that you consider outstanding examples of such material? Try to give enough information to locate the materials and/or some example websites having such material.
What material not currently available on the Web would you like to see there?
6. Roles of Libraries and Librarians
Is there a role in local areas for a trained librarian to have the time and resources to review and selectively distribute information to local practitioners that have established profiles of interest? Are there other particular services a local library should provide?
What other roles, talents, and/or software support would you see for librarians and for local libraries (e.g. knowledge of filling out disaster aid request forms, medical need forms, etc)
7. Extreme Events
If you had to consider an “extreme” but possible event such as a pandemic, would this add additional information requirements relevant to any of the other questions on this survey?
8. Your critical topic areas
In terms of creating an index (general ontology) out of a sample document database that can then be used to automatically classify new information as it occurs, what would you want included in such a database and what specific topic areas would you want to see in the resulting index or ontology?
9. International Considerations
The national Library of Medicine has an important role in aiding other countries in the accumulation and dissemination of medical information and knowledge.
- What specific contributions in the above disaster information areas might be important for NLM to provide internationally?
- What
contributions from other countries could be made to NLM in the disaster
information area? This could
include important sources in other countries not traditionally
disseminated in the
10. Others to include
Who else would you recommend should be asked to participate in this study and why in a sentence or two? (Please include name and email). Can your name be used in making contact with these individuals: Yes _____ No ______
11. Possible Workshop
If there were to be a future workshop (possibly in May 2008) including specific invitees to refine the results of this study and recommendations, would you be interested in participating:
Yes _____ No ______
Who else would you suggest be invited? Give email, address, and/or website and a sentence or two about them.
12. NLM experience (if not mentioned in
prior answers)
Have you ever used MEDLINE or any other NLM system to find information related to Emergency Preparedness or Management? If so characterize your experience and reaction.
13. Anything we left out
Please add any other information or comments that you think we should have asked for or any question you think should be added to this survey.
Choices
I am willing to be listed as a contributor to the report on the results of this survey:
YES ____NO ______
I do plan to follow up with a one page statement of a view point I wish to be identified with:
YES_____NO______
Please try to return this survey in four weeks or less (if you need more time please let us know). Also notify us if you cannot do any part of this survey. If you know someone you feel should do this survey you may send them a copy, but please email us that you have done so. You will receive the public report of this effort in 2008.
THANK YOU SO MUCH, on behalf of the National Library of Medicine!!
Please return via email with a word or text file attachment to:
murray.turoff@gmail.com) and roxanne.hiltz@gmail.com,
(Distinguished Professors, Emeriti, Department of Information Systems, New
Jersey Institute of Technology,
APPENDIX C
COMPLETE SET OF RESPONSES, ORGANIZED BY QUESTION and TYPE OF RESPONDENT
(As of
STUDY FOR THE NATIONAL LIBRARY OF MEDICINE ON INFORMATION REQUIREMENTS
FOR EMERGENCY PREPAREDNESS AND RESPONSE
NOTE: a blank line separates individual responses
2. Current Sources
What sources do you
currently consider as highly useful and important for emergency preparedness or
response missions with medical or public health implications (e.g. including
journals, organizations, websites, books, reports, plans, training materials,
services, etc).? Please give
specific information, e.g., journal or newsletter name, URL for a web site,
etc. If possible, also add a
sentence about how and in what type of situation this source has been used by
you.
1. Practitioners
Multiple web sites which I have organized myself in my own reference document: http://www.ynhhs.org/emergency/US_DHHS_web_sites.pdf
As general resources I tend to use the Pandemicflu.gov web site a lot, as well as LLIS.
Journal
of Public Health, Bioterrorism and Biosecurity, DHS list serve, HHS list serve,
Center for Disease Control and Prevention website, Natural Hazards Institute (
Humanitarian Practice Network/Overseas Development Institute – for best practices research, however I do not specialize in medical or public health research. All other sources fall outside the medical/public health domain.
HEALTH, pandemic—the granddaddy is CDC. The web sites that I use, mainly website is the department of Homeland Security/lessons learned, information systems. And it’s a website but more of a portal, the CDC website, the ready.gov and the World Health Organization.
Organizations:
CDC, FEMA, OFDA, USGS, NWS, WHO, UNICEF, UNHCR, DoD, universities, think
tanks like CSIS,
Journals:
Disasters
Disasters & Prehospital Medicine
Disaster Medicine and Public Health Preparedness (published by the AMA)
Weekly Morbidity & Mortality Report from the CDC
Websites:
PAHO: http://www.paho.org/english/DD/PED/home.htm
AlertNet: http://www.alertnet.org/
ReliefWeb: http://www.reliefweb.int/rw/dbc.nsf/doc100?OpenForm
CBS: http://www.cbsnews.com/digitaldan/disaster/disasters.shtml
CDC: http://www.bt.cdc.gov/disasters/
FEMA: http://www.fema.gov
Books and Manuals:
Public Health Consequences of Disasters
OFDA FOG Manual
MSF Series on emergencies (e.g., surgical care, epidemiology, mental health, obstetrics, communicable disease control, etc).
Disaster Medicine (by Ciottone et al)
THESE ALL HAVE BEEN USEFUL FOR TRAINING AND
RESEARCH. NOT SO MUCH DURING THE
RESPONSE AND RECOVERY PHASE WHEN THERE IS LITTLE TIME FOR
The best is REMM (www.remm.nlm.gov) for rad/nuc. I use CDC website, AFRRI and Google searches for specific topics. I don’t specifically read journals for this but do PUBMED searches.
I am interested in Rad/Nuc and use meetings, emails, and personal search to find them.
I
review GAO reports, Federal Guidance on Disaster Preparedness and subscribe to
(and write for) the on line publication, “Big Medicine.” Most of my sources are from the rich
experiences I gained from the Armed Services (An Air Force Medical Service
Corps Officer-
AHRQ Bioterrorism Site; various State’s Dept of Health preparedness sections websites, particularly for pan flu plans; DHS’s lessons learned site. Most journal articles I read are sent by others, I don’t have time to scan the journals and/or don’t have subscriptions. CDC site.
InfoMatrix is part of a larger set of tools developed for rapid, credible and accurate information sharing for a variety of audiences during a chemical. It is found at the web page maintained by the Michigan Department of Community Health (MDCH) Chemical Terrorism and Emergencies Unit. (As of January 2008, see http://www.michigan.gov/mdch/0,1607,7-132-2945_5105-98025--,00.html to link to the latest matrix document, available in .pdf format.). Currently, the InfoMatrix is maintained and updated by the ICTW and given a permanent WWW link on the MDCH web page listed above.
Other extremely useful tools I have used extensively as part of ongoing public health investigation include:
- CAMEO (Computer Aided management of Emergency Operations), a suite of programs that includes a GIS application (MARPLOT) and a plume modeling mapping application (ALOHA) – a free resource from the National Oceanic and Atmospheric Association with significant cross-jurisdiction and knowledge maintained in the Environmental Protection Agency Office of Emergency Management.
- I have used ALOHA to visualize rough plume magnitude and direction, but have used it primarily as a training tool, teaching local public health emergency preparedness partners its utility in a chemical emergency
- WISER (Wireless Emergency Information System for Emergency Responders), a free download from the National Library of Medicine and available for several handheld platforms as well as a pure online version (WebWISER).
- WebWISER and WISER for Windows I used in most of the investigations I have personally participated in since these tools were made available, including a nationally reported “outbreak” of mass psychogenic illness transmitted via “line of sight” in Saline High School (Michigan). For more information, see http://www.michigan.gov/documents/SalineHighSchoolHC060906_163234_7.pdf
Organizations: New York City Department of Health and Mental Hygiene, New York State Department of Health, New Jersey Department of Health and Senior Services, Center for Disease Control, Department of Homeland Security, EPA, NIOSH, Department of Homeland Security Digital Library and the web sites associated with these organizations. Direct coordination and collaboration is absolutely essential for the Port Authority of NY & NJ’s Bio-defense strategy and preparedness. Homeland Security Digital Library
2. Medical and Health Professionals
I have used a host of resources depending on the topic on which I was focused.
I routinely use NLM’s PubMed for lit searches.
I frequently use government websites such as NOAA (
General
readings include the International Society for Traumatic Stress Studies (ISTSS)
– newsletters and journal. I frequently consult the VA’s
I
follow Biosecurity and Bioterrorism:
Biodefense Strategy, Practice, and Science to stay abreast of thoughtful
analyses of issues I’m working on..
I search the GAO website and
Other journals that have been helpful include Predisaster Hospital Medicine and major Emergency Medicine journals. I’ve looked at the new JAMA series on disaster medicine.
I receive a weekly newsletter for
the
I am an associate member of the National Public Health Information Coalition which has been a valuable way of learning about what states are doing and how they are messaging. I also used this organization during Hurricane Katrina (unofficially) to quickly find out how much tetanus toxoid was on hand in the state health departments affected. http://www.nphic.org/
In a similar vein, I periodically check the National Association of County and City Officials to learn about state and local issues. http://www.naccho.org/
Organizations:
CDC – Emergency Preparedness and Response Listing: http://www.bt.cdc.gov/
American Red Cross: http://www.redcross.org/services/disaster/
FEMA: http://www.fema.gov/
CINDI: http://cindi.usgs.gov/
NESDIS: http://www.nesdis.noaa.gov/
USGS: http://www.usgs.gov/
DHS: http://www.dhs.gov/index.shtm
NYC OEM: http://www.nyc.gov/html/oem/html/home/home.shtml
Biosafety in Microbiological & Biomedical Laboratories
(BMBL)
Case Definitions for Selected Infectious Diseases
CDC Recommends: The Prevention Guidelines System
Emerging Infectious Diseases
Journal
Geographic Analysis Tool for
Health & Environmental Research (GATHER)
Geographic
Information Systems (GIS) & Public Health
National
Laboratory Training Network (NLTN)
Public
Health Training Network (PHTN)
Association of Public Health
Laboratories (APHL)
Association of State &
Territorial Health Officials (ASTHO)
Center for
Biosecurity, University of Pittsburgh Medical Center (UPMC)
Center for
Infectious Disease Research & Policy
Center for Nonproliferation
Studies
Centers for Public
Health Preparedness (CPHP)
Defense Threat Reduction Agency
(DTRA)
Department of Homeland Security
(DHS)
Food & Drug Administration (FDA): Bioterrorism
Health Resources & Services
Administration (HRSA)
MedlinePlus: Biodefense and Bioterrorism
National Association of Local
Boards of Health (NALBOH)
National Institute of Allergy & Infectious Diseases
(NIAID): Bioterrorism
National Library of Medicine (NLM): Biological Warfare
United States Postal Service (USPS) guidance regarding
harmful biological or chemical weapons
U.S. Army
Medical Research Institute of Infectious Diseases (USAMRIID)
Journals/DB:
Journal of Disaster Studies Policy and Management
American Society of Professional Emergency Planners
Australian Journal of Emergency Management
Contingency Planning & Management
Disasters
Disaster Prevention and Management
Disaster Recovery Journal
Disaster Resource
The Electronic Journal of Emergency Management
Hazards Literature Database Natural Hazards Research/Appl Info Cntr,
U. CO,
International Journal of Mass Emergencies and Disasters
Journal of Civil Defense
Journal of Contingency and Crisis Management
Journal of Environmental Management
Natural Hazards Observer
Natural Hazards Review
Australasian Journal of Disaster and Trauma Studies
Banks in Insurance Report
Disaster Prevention and Management: An International Journal
Risk Analysis
Environmental Hazards
Global Environmental Change Part B: Environmental Hazards
Journal of 9/11 Studies
Journal of Hazardous Materials
Journal of Humanitarian Assistance
Natural Hazards
Pre-Hospital and Disaster Medicine
Crisis Disaster and Risk Management
Journal of Organizational and Business Continuity
I think the predominate source would be the CDC website when we’ve have any activities that we’ve had to really had to worry about we’ve gone on there for a least an initial cut on what might happen. DHS websites and in general other websites. The ability to search on a web site makes it easier to get to the information even if you have a book that might have what you’re looking for you don’t have the search capability that electronically you could have.
Prehospital and Disaster Medicine
Annals of Emergency Medicine
Disaster Medicine (2 textbooks – Burnstein & Hogan; Cittone)
CDC website
DHS website
ATSDR website
3. Other Professionals
3.1 Librarians
Basic reference texts such as the PDR, Washington Manuals or other similar pocket medicine handbooks, Merck Manual, an Atlas of Dermatology, Toxicology and Biological warfare manuals, Guidelines on Pandemic Flu, Aurbach’s Emergency Medicine, any reference on setting fractures and/or rudimentary surgical procedures, an all-encompassing diabetes reference, possibly a psych manual.
American Red Cross (www.redcross.org)
Local Red Cross locator, detailed instructions for preparing a disaster kit, foreign language materials
Amigos Library Services (www.amigos.org)
Sample disaster plan template
Centers for Disease Control (www.cdc.gov)
Fact sheets and brochures on specific health issues, statistical data, software and databases, 24-hour emergency telephone number
Citizencorps.gov (www.citizencorps.gov)
Coordination of volunteer activities and public preparedness in the event of a disaster
Community Emergency Response Teams (CERT) (www.citizenscorp.gov/cert)
Empowering citizens to become active in their communities, disaster preparedness and recovery education
Disaster Planning for Health Sciences Libraries (dtw2t.wordpress.com/)
Blog discussion on disaster
planning from the
Federal Emergency Management Agency (FEMA) (www.fema.gov)
Disaster preparedness, response and recovery
National Incident Management System (NIMS) Incident Command System (ICS) (www.nimsonline.com/nims_training/index.htm)
Essential training for anyone who does or will respond to major (or even minor) incidents, training required for FEMA funding
National Oceanic & Atomospheric Administration (NOAA) (www.noaa.gov)
Real-time weather, satellite images, warnings for severe weather,
Ready.gov (www.ready.gov)
Instructions for creating safety kit, safety plans, information on being prepared
Solinet (www.solinet.net)
Disaster prevention and protection checklist
Weather Channel (www.weather.com)
Weather glossary & encyclopedia, current weather conditions, five-day forecasts, severe weather alerts, local weather, travel information
3.2
Academics/Researchers
One of the most valuable sources for me is to attend the annual APHL (Association of Public Health Laboratory) National Conference and also to meet with various directors of public health laboratories. I learn more about the requirements and needs of public health laboratories during a public health emergency and then analyze how information technology can provide solutions.
Books
- Emergency Management, the American Experience 1900-2005, Claire Rubin, Ed
- Jane’ s Guide to Hospital Emergency Management and Response Joseph Barbera
- Managing the Unexpected, Karl Weick
- Individual and Community Responses to Trauma and Disaster Robert Ursano
- International Disaster Management, Damon Coppola
Technical Reports
- Medical and Health Incident Management (MaHIM), J. Barbera and A. Mcintyre, on ICDRM website, www.gwu.edu/~icdrm
Journals/publications
- Natural Hazards Observer
- Journal of Homeland Security and Emergency Management
- Journal of Prehospital and Disaster Management
Web Sites
- FEMA higher education project (www.fema.gov/institutions/universities)
- Public Entity Risk Institute (www.riskinstitute.org)
- Relief web (www.reliefweb.int)
- Homeland security digital library (www.hsdl.org)
- FEMA national integration center (www.fema.gov/nims)
- Emergency Management Accreditation Program (EMAP) (www.emaponline.org)
Two resources are most applicable for both public and private sector entities:
1) Project Public Health Ready is a collaborative venture between the Centers for Disease Control and Prevention and the National Association of County and City Health Officials, Last published in 2006, this program evaluates local health department response plans to determine whether the jurisdiction is prepared to carry out all of its responsibilities in the event of an emergency. Response plan strength on such issues as workforce competency development, surge capacity, epidemiologic investigations, communications, and practice exercises are evaluated.
2) Local Public Health Preparedness and Response Capacity Inventory is a self-assessment designed by the CDC to help local health agencies evaluate their plans to respond to public health emergencies. It emphasizes legal preparedness, personnel development, surge capacity, risk communication, laboratory capacity, and vaccine distribution. (CDC, 2002).
I am a researcher interested in how multiagent systems can be used for modeling and simulating emergency response.
- International Journal of Emergency Management
- ISCRAM Conference Proceedings
- ISCRAM Website http://www.iscram.org/
- In general, any workshop proceedings concerning modeling and simulation for emergency response
- Robocup Rescue website: http://www.rescuesystem.org/robocuprescue/index.html
- AAMAS Conference (in particular how agent technology is used for Disaster Management http://users.ecs.soton.ac.uk/sdr/atdm/)
Humanitarian Practice Network/Overseas Development Institute – for best practices research, however I do not specialize in medical or public health research. All other sources fall outside the medical/public health domain.
The existing literature providing actionable guidance for public health incident response is limited. The most useful documentation is obtained from other fields and must then be adapted to public health:
- Coast Guard guide to ICS – especially the sections on Incident Action Planning
- Medical and Health Incident Management (MaHIM) System: A Comprehensive Functional System Description for Mass Casualty Medical and Health Incident Management (2002)
- MSCC (Medical Surge Capacity & Capability)
- VHA Emergency Management Curriculum (see ICDRM website)
- Retrospective case studies & after action reports (these are white-washed and limited in their utility but reading between the lines and identifying the key issues can be very useful):
- GAO Reports on the response to West Nile Virus ’99; Anthrax 2001; XDR-TB
- MMWR
- EID (much more clinical & international in its focus)
- CDC/HHS/DHS plans (strategic guidance to preparedness planning; often disconnected from practical response requirements which minimizes the utility of these documents)
- Dark Winter & Topoff reports contain interesting observations and characterizations of public health organizational and decision-making tendencies when engaged in a response.
- For biological agent specific information (incubation period; clinical diagnosis; prophylaxis etc…) JAMA, EID and other journals are useful. CDC.gov
- Promed is an excellent source of information when searching for information on previous outbreaks or incidents.
- Electronic Journal Databases:
- Global Health
- Ovid Medical
- Journals – public health journals that sometimes publish interesting pieces related to emergency management:
- The Journal of Public Health Management & Practice
- Public Health Policy
- The
Journal of Urban Health (NY
Please
see attached slides for data and
references (appendix). Prehospital and
Disaster Medicine (http://pdm.medicine.wisc.edu);
MMWR; Science; Nature; J. Trauma
Stress; Int Rev Psychiatry; South Med J; Annals of Emergency Medicine; Disasters.
The website of the World Association for Disaster and Emergency Medicine
(http://www.wadem.org) and its Newsletter, Insight; Disasters newsletter and
other publications of the Pan-American Health Organization (www.paho.org)
(AMRO); Bull WHO; Special publications Department of WHO
from Health Actions in Crisis, especially reports from Expert Consultations
(most published in PDM)( www.who.int/entity/hac/about/structure/en/index.html);
Ann Surg; J Trauma; N Engl J Med; World Congresses on Disaster and Emergency
Medicine of the WADEM; European Masters in Disaster Medicine (www.dismedmaster.com); Japanese J Disaster
Medicine; Asia-Pacific Conferences on Disaster Medicine;. Also, check out
the extensive bibliography of the
4. International Professionals
ReliefWeb (www.reliefweb.int)
Various ODI Humanitarian Practice Network Publications (http://www.odihpn.org/hpnpubs.asp)
Disasters (http://www.blackwellpublishing.com/journal.asp?ref=0361-3666&site=1)
Journal of Humantarian Assistance (http://www.jha.ac/)
In
an acute response phase, real-time information from the site of the event is
most important. Sources include situation reports from International
Organisations involved in first response (UN and others) and national/regional
responders already on-site.
Background
information about general local conditions and specific (e.g. health) aspects
are useful, but in the initial response phase there is no time for in-depth
consultation of such sources.
http://pdm.medicine.wisc.edu/
I am not a public health responder or professional. My focus is on strategic planning, particularly with respect to applying knowledge management principles and practices to science-based departments and emergency management. My sources of information and knowledge are highly diverse, rather than tied to specific journals. I am connected to a handful of national and global knowledge management networks. These often point to useful or interesting articles in various professional and scientific journals. I may pose a specific question to these networks to get me started on a search. This often results in a pointer to a web site with what I’m looking for. I often also go to Wikipedia as a point of departure when exploring new areas that I am unfamiliar with.
I
used to go to national libraries in both
http://www.reliefweb.int/rw/dbc.nsf/doc100?OpenForm
most information, first general and by clicking detailed information per source.
medical info, situations and guidelines
https://www-secure.ifrc.org/dmis/login.asp
deployment information and situation repports
alerts, situation
reports, maps
http://ec.europa.eu/environment/civil/prote/mic.htm
EU info,
technical capacities, support
https://www.cia.gov/library/publications/the-world-factbook/index.html
country information
medical information, backgrounds, guidelines
specific hazard information
maps
diseases, tropical guidelines, vaccination, country specific
questions (
http://www.iph.fgov.be/Index.asp?Lang=NL
specific and environmental related problems
UNDAC handbook, and OCHA information in general.
Diplomatic network - the Belgian Embassy in the affected country
Used,
and found useful, the following: Pubmed, MedScape, International Trauma Life
Support (ITLS) courses. While I can
not specify a particular journal as the best source for guidelines, algorithms
and educational reviews, it may be useful to construct a database or search
engine to encompass most relevant articles from various sources. These can come
from either peer-reviewed journals, or from other public media (TV, newspapers
etc.) Websites run by local
national trauma organizations may provide excellent basis for such solutions.
3. Desired Sources
3.a. For emergency preparedness or response
missions with medical or public health implications: What useful resources, services, or
types of information are now missing or difficult to access or use, that you
would like to see more readily accessible to all concerned? (either for a
specific type of medical disaster such as a pandemic flu, and/or for general
health aspects of emergencies;
i.e., disease outbreaks after hurricanes or earthquakes).
1. Practitioners
I think the problem is not resources, it is finding the right ones and then knowing which resources are authoritative. A web search on any given topic will likely turn up multiple resources.
Easily accessible lists of potential contractors sorted by actual (rather than professed), proven areas of expertise; coherent journal pulling together selected articles that focus on emergency preparedness and response from wealth of sources (e.g., public health-related journals) in which those articles may be buried.
mailing lists posted at: http://www.preventionweb.net/
You
should have a process in place that will say who will build the list, who will
put out the assistance guide… the front line, the clean up volunteers is
easiest to get. Moving back, case
workers, that’s a little harder to find. Who will coordinate the 100s of
volunteers that are willing to go into your basement and take mud out (tell you
what to do and where to go). In NJ
211 will take the request; there
are 3 or 4 organizations inside and out of NJ to come in and clean up your
basement. 211—who is that? It is the Methodists in one county,
somebody else in another county.
I’m
looking for information for people who have health related problems that they
think are 911 related, but they are outside the criteria of the organizations
now… if you have needs outside my area of expertise i don’t know where to send
you. Nobody will talk to me about
how to get help to pay rent because you can’t work.
We
are trying very hard to make it common practice that every disaster large and
small produces a complete and accurate guide as to where you, in this disaster,
can get help and information you need.
For example, how much bleach to I put in to prevent mold? How do i get help or information.. Eg, to call somebody
who will put pressure get money from my own insurance company?... Anyway, a
needs based, disaster victim oriented, comprehensive, up to date, accurate
assistance guide--which does not talk about agencies but is agency
centered. Which is organized by
need, not by agency. This does not
exist today, I hold my breath until somebody puts this together for each
disaster.
Information about what other organizations are doing. What supplies, equipment, medications and personnel are “in the pipeline” on route to a disaster scene. Unfortunately, we are still depending on traditional (read: antiquated) means of communication:
I admit to being bias but the product that NLM has done with HHS, REMM is superb. It has all the information one needs- or darn close- to manage a radiation event.
Rad/nuc info is difficult to aggregate and find. Needs to be made intellectually accessible to those without radiation expertise. Using multimedia helps as this area is very technical. I work with those without expertise. Those with expertise don’t need this. Audience in this area is very diverse.
Disaster, “After Action Reports”, especially where lessons were NOT learned and the same deficiencies were present over time.
What FEMA planning course calls “implementing information” Standard Operating Guidelines (SOGs), equipment lists, job action sheets, MOUs/MOAs. There is a lot of clinical information, much of which is redundant, and not enough logistics and management info (by comparison).
There could be more user friendly models, like spread sheets, to estimate supply and personnel needs.
Data bases of existing health and medical organizations and resources and a database to track resources – hence the PHP DSS project I’ve been working on.
A comprehensive bio-defense strategy includes notification, response, and recovery from any type of biological event including pandemic, terrorism, or naturally occurring diseases. Bio-defense objectives include rapid detection, rapid decision making, rapid treatment, and rapid recovery, and throughout this process, public health’s ability to provide timely and accurate information related to public health risk is absolutely critical to decision makers.
Public Health’s role is to conduct a risk assessment of the situation (epidemiological and clinical, syndromic surveillance, etc.) and provide timely and accurate information to the stakeholders to maintain a common operational picture and more important make good decisions. Real time accessibility to essential elements of critical public health information during a biological event is key for decision makers. Right now there is no process or mechanism in place to share this information.
Interesting question. What I find terribly frustrating is the inability for ‘internationals’ to gain access to the considerable resources of a wide spectrum of US DHS resources sites and listservs.
2. Medical and Health Professionals
I think that websites such as REMM that are vetted by experts and provide rapid access to what you need to know in order to manage a certain event are terrific.
It would be ideal if there were similar one-stop-shopping sites for other threats. They would need a point person or two to communicate with experts to update the latest information and delete outdated recommendations.
A database with Disaster related instruments:
Pre Disaster HVAs instruments.
Psychosocial Assessment tools
Post Disaster Response Assessment instruments.
A database with National/Sate/City protocols and intervention plans
A data repository with National/Sate/City disaster drill data
A centralized data repository with raw data re published or research in progress
I
think practical response advice what i would call on the CDC website technical
response. So, for example, if an
event takes place I don’t necessarily need all the background information at
that point i need the first steps or the checklist to go through of what to go
through. So some sort of single
source immediate action items advise, histories backgrounds etc for fast breaking
activities. And i also think it has to be a source that is recognized as the
accepted source because having ten different book from ten different companies
or authors calls into question as to which one you should go to.
Best
practices, best practices with summaries so if I wanted to know what the best
way to handle an event is, I could easily find the best practices but not have
to read the whole document to do that.
3. Other Professionals
3.1 Librarians
An
electronic point of care database like