Global & Disaster Medicine

Archive for the ‘Public Health’ Category

NDMS: The nation’s medical tactical response team in times of disaster


DMAT: Disaster Medical Assistance Team which is a fully functioning field hospital that can handle everything from minor injuries to bruises and broken bones. The team travels with a host of medical professionals and gear.

DMORT: Disaster Mortuary Operational Response Team which can handle mass-casualty situations. Once they set up, they handle the identification of remains by using scientific techniques as well as collecting information about the deceased from family members.



NVRT: National Veterinary Response Team is a team of veterinary professionals to care for both the working and victims animals in an affected area.

IRCT: Incident Response Coordination Team is deployed to keep track of and coordinate the multifaceted response.

IMSURT: International Medical Surgical Response Team essentially sends the operating room to the field — sort of a M.A.S.H. unit for disasters — to handle major trauma.

USPHS: U.S. Public Health Service will also send trained medical professionals to assist for one-stop manpower shopping.


In Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism, 26 states and Washington, D.C. scored a six or lower on 10 key indicators of public health preparedness.


Ready or Not? examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies. Some key findings include:

  • 26 states increased or maintained funding for public health from Fiscal Year (FY) 2014-2015 to FY 2015-2016.
  • Just 10 states vaccinated at least half of their population (ages 6 months and older) against the seasonal flu during the 2015-2016 flu season (from July 2015 to May 2016).
  • 45 states and Washington, D.C. increased the speed of DNA fingerprinting using pulsed-field gel electrophoresis (PFGE) testing for all reported cases of Shiga toxin-producing E. coli O157, a measure of a state’s ability to detect foodborne outbreaks.
  • 10 states have a formal access program or a program in progress for getting private sector healthcare staff and supplies into restricted areas during a disaster.
  • 30 states and Washington, D.C. met or exceeded the overall national average score (6.7) of the National Health Security Preparedness Index (as of 2016).
  • 32 states and Washington, D.C. received a grade of C or above in States at Risk: America’s Preparedness Report Card, a national assessment of state-level preparedness for climate change-related threats – which have an impact on human health.

In addition, the report examined trends in public health preparedness over the last 15 years, finding successes and ongoing concerns.

  • One-third of funds for health security and half of funds for healthcare system preparedness have been cut: Health emergency preparedness funding for states has been cut from $940 million in fiscal year (FY) 2002 to $660 million in FY 2016; and healthcare system preparedness funding for states has been cut by more than half since FY 2005 – down to $255 million.
  • Some major areas of accomplishment: Improved emergency operations, communication and coordination; support for the Strategic National Stockpile and the ability to distribute medicines and vaccines during crises; major upgrades in public health labs and foodborne illness detection capabilities; and improvements in legal and liability protections during emergencies.
  • Some major ongoing gaps: Lack of a coordinated, interoperable, near real-time biosurveillance system; insufficient support for research and development of new medicines, vaccines and medical equipment to keep pace with modern threats; gaps in the ability of the healthcare system to care for a mass influx of patients during a major outbreak or attack; and cuts to the public health workforce across states.

The Ready or Not? report provides a series of recommendations that address many of the major gaps in emergency health preparedness, including:

  • Requiring strong, consistent baseline public health Foundational Capabilities in regions, states and communities-so that everyone is protected.
  • Ensuring stable, sufficient health emergency preparedness funding to maintain a standing set of foundational capabilities alongside a complementary Public Health Emergency Fund which would provide immediate surge funding during an emergency.
  • Improving federal leadership before, during and after disasters – including at the White House level.
  • Recruiting and training a next generation public health workforce with expert scientific abilities to harness and use technological advances along with critical thinking and management skills to serve as the Chief Health Strategist for a community.
  • Reconsidering health system preparedness for new threats and mass outbreaks by developingstronger coalitions and partnerships among providers, hospitals, insurance providers, pharmaceutical and health equipment businesses, emergency management, and public health agencies.
  • Prioritizing efforts to address one of the most serious threats to human health by expanding efforts to stop Superbugs and antibiotic resistance.
  • Improving rates of vaccinations for children and adults – which are one of the most effective public health tools against many infectious diseases.

Ready or Not? was released annually from 2003-2012, and more recently, TFAH has released Outbreaks: Protecting Americans from Infectious Diseases, from 2013-2015.The report was supported by a grant from the Robert Wood Johnson Foundation (RWJF).

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s website. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials.

10 out of 10: Massachusetts

9 out of 10: North Carolina and Washington

8 out of 10: California, Connecticut, Iowa, New Jersey, Tennessee and Virginia

7 out of 10: Colorado, Delaware, Florida, Indiana, Maryland, Michigan, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, South Carolina, Utah and Wisconsin

6 out of 10: Arizona, Arkansas, District of Columbia, Georgia, Hawaii, Illinois, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Montana, Nebraska, Ohio, Pennsylvania, Texas and Vermont

5 out of 10: Alabama, Missouri, Oklahoma, South Dakota and West Virginia

4 out of 10 Nevada and Wyoming

3 out of 10: Alaska and Idaho

Trump & Deadly Disease

NY Times

  • “…..President Trump’s budget would cut funding for the National Institutes of Health by 18 percent.
  • It would cut the State Department and the United States Agency for International Development, a key vehicle for preventing and responding to outbreaks before they reach our shores, by 28 percent.
  • And the repeal of the Affordable Care Act would kill the billion-dollar Prevention and Public Health Fund, which provides funding for the Centers for Disease Control and Prevention to fight outbreaks of infectious disease.
  • (While the budget also calls for the creation of an emergency fund to respond to outbreaks, there is no indication that it would offset the other cuts, or where the money would come from.)
  • We are already witnessing an outbreak of influenza in birds — the H7N9 strain, in China — that could be the source for the next human pandemic. Since October, over 500 people have been infected; more than 34 percent have died. Most victims had contact with infected poultry, yet three recent clusters appear to be from person-to-person transmission. Will H7N9 mutate to become easily transmitted between humans? We don’t know. But without sufficient supplies of a vaccine, we are not prepared to stop it…….”

OHIO: Six out of 10 on Key Indicators Related to Preventing, Detecting, Diagnosing and Responding to Outbreaks


Ready or Not? examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies.  Some key Ohio findings include:

No. Indicator Ohio Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Public Health Funding Commitment: State increased or maintained funding for public health from FY 2014 to FY 2015 and
FY 2015 to FY 2016.
Y 26
2 National Health Security Preparedness Index: State met or exceeded the overall national average score (6.7) of the National Health Security Preparedness IndexTM, as of 2016. 30 + D.C.
3 Public Health Accreditation: State had at least one accredited public health department. Y 43 + D.C.
4 Flu Vaccination Rate: State vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2015 to Spring 2016. 10
5 Climate Change Readiness: State received a grade of C or above in States at Risk: America’s Preparedness Report Card. 32 + D.C.
6 Food Safety: State increased the speed of DNA fingerprinting using pulsed-field gel electrophoresis (PFGE) testing for all reported cases of E. coli. Y 45 + D.C.
7 Reducing Healthcare-Associated Infections (HAIs): State implemented all four recommended activities to build capacity for HAI prevention. Y 35 + D.C.
8 Public Health Laboratories: State public health laboratory provided biosafety training and/or provided information about biosafety training courses for sentinel clinical labs (from July 1, 2015 to June 30, 2016). 44
9 Public Health Laboratories: State public health laboratories reported having a biosafety professional on staff (from July 1, 2015 to June 30, 2016). Y 47 + D.C.
10 Emergency Healthcare Access: State has a formal access program or a program in progress for getting private sector healthcare staff and supplies into restricted areas during a disaster. Y 10
Total 6

These 100 objects have made their mark on public health.

100 Objects

A list of 100 objects to recognize the Centennial of the Johns Hopkins Bloomberg School of Public Health — and to help us appreciate the vast reach of public health.


9/11 & disaster-related adverse birth outcomes.


Carey B. Maslow, Kimberly Caramanica, Jiehui Li, Steven D. Stellman, and Robert M. Brackbill.  (2016). Reproductive Outcomes Following Maternal Exposure to the Events of September 11, 2001, at the World Trade Center, in New York City. American Journal of Public Health. e-View Ahead of Print.

Pictograms designed to promote universal access to emergency dispensing sites services

Cambridge PH

Pictogram-based Signs for Mass Prophylaxis Services

In 2007, the Cambridge Advanced Practice Center for Emergency Preparedness developed a series of pictograms designed to promote universal access to emergency dispensing sites services. The signs were developed in collaboration with local and state public health professionals, and experts in universal design and accessibility.

These signs provide:

  • Large, high contrast pictograms of station activities. Select from up to 10 station signs!
  • Simple, one-word descriptions in English and Spanish. Available in 13 other languages!
  • Four-step process sign
  • All-hazards approach to allow versatility and scalability

To obtain high resolution PDFs of the signs or for more information, please email
Process Sign
Process Sign

Enter Sign

Start Sign

Registration Sign

Screening Sign

Treatment Sign

Children Sign

Wait Sign

Exit Sign

Aid Sign

Signs for PODs, Medication and Health Care Centers

Washington State DOH

Signs for Medication and Health Care Centers

Below is a complete list of signs you can use in health care and medication centers. Advice about ways to use the signs can be found on the page about planning these emergency centers. The signs may be available in multiple languages, different formats. You will be able to customize the signs for your jurisdiction or facility.

The file may be presented in one or both of two formats:

  • Adobe InDesign format: High-quality files for printing larger signs through your local print-shop or customizing the signs for your location.
  • PDF format: For printing to smaller format printers or plotters.

If you have questions or need help, write to


Medication Center/Health Care Center Signs

Moving through
the centers

Staff in vests

Waiting area; Please wait; Wait for staff

Authorized personnel only
At the Medication Center

Medication Center greeting/Exit

Four Simple Steps

Medication Center banner

Medical evaluation

Nurse station

No refills of medication

Adult line/Family line


At the Health Care Center

Three simple steps

Health Care Center banner


Entering and exiting Entrance/No entrance

Staff/Volunteer entrance

Thank you for your cooperation

Exit/No exit

Assistance and
internal operations
Prohibited Items


Authorized personnel only

Incident Command Post

Staff in Vests

Signs for staff





Patient privacy

Interpretation and
special needs
Interpretation Tools
Clinical setting Medical evaluation/First aid

Nurse station

Wash hands often

Cover Your Cough

Number and letter signs


Ambulance/Patient loading

Logistics Deliveries

Ambulance/Patient loading

Other signs Emergency Preparedness Drill sign and banner

What are CARPHA & PAHO?


The Caribbean Public Health Agency (CARPHA) is the new single regional public health agency for the Caribbean. It was legally established in July 2011 and began operation in January 2013. The Agency is the Caribbean Region’s collective response to strengthening and reorienting our health system approach to address the changing nature of public health challenges. For more information visit:

About PAHO

PAHO, founded in 1902, is the oldest international public health organization in the world. It works with its member countries to improve the health and the quality of life of the people of the Americas. It also serves as the Regional Office for the Americas of WHO. For more information visit

Venezuela: In hospitals, supplies are lacking, electricity goes out, equipment is broken and patients lie in pools of blood.

NY Times



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