Introduction:During 2005, Hurricanes Katrina and Rita struck the US Gulf Coast, displacing approximately two million people. With >250,000 evacuees in shelters, volunteers from the American Red Cross (ARC) and other nongovernmental and faith-based organizations provided services. The objective of this study was to evaluate the composition, pre-deployment training, and recognition of scenarios with outbreak potential by shelter health staff.Methods:A rapid assessment using a 36-item questionnaire was conducted through in-person interviews with shelter health staff immediately following Hurricanes Katrina and Rita. Data were collected by sampling at shelters located throughout five ARC regions in Texas. The survey focused on: (1) public health capacity; (2) level of public health awareness among staff; (3) public health training prior to deployment; and (4) interest in technical support for public health concerns. In addition, health staff volunteers were asked to manage 11 clinical scenarios with possible public health implications.Results:Forty-three health staff at 24 shelters were interviewed. Nurses comprised the majority of shelter health volunteers and were present in 93% of shelters; however, there were no public health providers present as staff in any shelter. Less than one-third of shelter health staff had public health training, and only 55% had received public health information specific to managing the health needs of evacuees. Only 37% of the shelters had a systematic method for screening the healthcare needs of evacuees upon arrival. Although specific clinical scenarios involving case clusters were referred appropriately, 60% of the time, 75% of all clinical scenarios with epidemic potential did not elicit proper notification of public health authorities by shelter health staff. In contrast, clinical scenarios requiring medical attention were correctly referred >90% of the time. Greater access and support from health and public health experts was endorsed by 93% of respondents.Conclusions:Public health training for sheltering operations must be enhanced and should be a required component of pre-deployment instruction. Development of a standardized shelter intake health screening instrument may facilitate assessment of needs and appropriate resource allocation. Shelter health staff did not recognize or report the majority of cases with epidemic potential to public health authorities. Direct technical support to shelter health staff for public health concerns could bridge existing gaps and assist surveillance efforts.

No abstract

The Palestinian emergency healthcare system faces numerous difficulties in its efforts to develop and improve patient care. The Emergency Medical Assistance Project, a four-year, emergency health capacity-building project, is described in this report. The factors contributing to the current lack of inhospital emergency care and the measures performed to improve the situation are highlighted. The authors surveyed 48 emergency healthcare providers in the West Bank and Gaza Strip on key emergency care development indicators and compared the level of emergency health development with those of Israel and the United States using a model of structured development criteria. Survey results and project observations provide a basis for future recommendations in education and infrastructure.

in support of the United Nations Development Programme (UNDP)sponsored project entitled Poverty Alleviation and Humanitarian Assistance in the Tumen River Area, which is adjacent to North Korea. Before launching the program, a survey and field assessment were done that identified a large knowledge and skill gap between city hospitals and rural clinics, and a lack of disaster preparedness, even after the outbreak of severe acute respiratory syndrome (SARS). The program was divided into three phases fostering full participation from January 2003 to January 2005. Each phase followed four steps: (1) needs assessment/planning; (2) curriculum development/customizing; (3) implementing; and (4) evaluation. The first phase consisted of a 10-day workshop to train 30 trainers from eight countries in the Yanbian area as key partners. In the second phase, 300 doctors and nurses from eight counties participated in a five-day workshop consisting of lecturing, arranging, and evaluation by the participants from the first phase. Between the first and second phases, the researchers and local lecturers published a Chinese textbook on Emergency and Disaster Preparedness, which was the first in China. The third phase was a two-day workshop for approximately 900 rural doctors who dealt with emergency cases. Since the educational background of rural doctors varies from elementary school to bachelor's degrees, another five-day train-thetrainers session was conducted for 32 rural doctors prior to the main sessions, with the curriculum and language customized to meet their educational levels. Remarkably, the participants of each session expressed >90% satisfaction of the training and materials, and showed a significant improvement between pre-test and post-test scores. Participants were involved positively during Morning Recap (recapitulation) time and role-play. Throughout the training program, strong cooperation and participation was seen between Yanbian governmental officials and participants. In conclusion, small control and large autonomy motivates a strong partnership and sustainability in emergency care.