Leveraging the Public Health Emergency Operation Center (PHEOC)for pandemic response: opportunities and challenges

Public Health Emergency Operation Center (PHEOC) was conceptualized and established for coordinatinginformation and resources towards goal-oriented response in large scale public health emergency. Yet, theactivities undertaken by PHEOCs and their intended goals have not been fully optimized in current scenario.This paper revisited the collective efforts invested in PHEOC conceptualization and development, identified theopportunities and challenges in compliance with standards and framework, demonstrated the accountabilityof PHEOC network, thereby promoted best practice guidance for global public health emergency preparednessand response. This review will help navigate emergency response complexities leveraging PHEOC partnershipsand advance the ability to detect and respond to public health emergencies in low resource settings. The reviewshows that the information on how to adapt best practice guidance to local circumstances could incentivizethe full implementation of prevention, early detection and response to outbreaks. Identifying and correctingdeficiencies in effectiveness evaluation will provide the basis for continuous PHEOC improvement. With thegradually reopening economies and public services in some countries, there is an urgent need to emphasize andvalidate the collective efforts undertaken by PHEOCs for tackling the COVID-19 pandemic.

Randomized Controlled Study on Safety and Feasibility of Transfusion Trigger Score of Emergency Operations

Background： Due to the floating of the guideline, there is no evidence-based evaluation index on when to start the blood transfusion for patients with hemoglobin （Hb） level between 7 and 10 g/dl. As a restdt, the trigger point of blood transtiision may be different in the emergency use of the existing transfusion guidelines. The present study was designed to evaluate whether the scheme can be safely and effectively used for emergency patients, so as to be supported by multicenter and large sample data in the future. Methods： From June 2013 to June 2014, patients were randomly divided into the experimental group （Peri-operative Transfusion Trigger Score of Emergency [POTTS-E] group） and the control group （control group）. The between-group differences in the patients＇ demography and baseline inlbrmation, mortality and blood transfusion-related complications, heart rate, resting arterial pressure, body temperature, and Hb values were compared. The consistency of red blood cell （RBC） transiiision standards of the two groups of patients with the current blood transfusion guideline, namely the compliance of the guidelines, utilization rate, and per-capita consumption of autologous RBC were analyzed. Results： During the study period, a total of 72 patients were recorded, and 65 of them met the inclusion criteria, which included 33 males and 32 females with a mean age of（34.8 ± 14.6） years. 50 tmderwent abdomen surgery, 4 underwent chest surgery, 11 underwent arms and legs surgery. There was no statistical difference between the two groups for demography and baseline inlbrmation. There was also no statistical differences between the two groups in anesthesia time, intraoperative rehydration, staying time in postanesthetic care unit, emergency hospitalization, postoperative 72 h Acute Physiologic Assessment and Chronic Health Evaluation II scores, blood transliision-related complications and mortality. Only tile POTTS-E group on the 1st postoperative day Hb was lower than group control, P 〈 0.05. POTTS-E group was totally （100%） conlbrmed to the requirements of the transfusion guideline to RBC inliision, which was higher than that of the control group （81.25%）, P 〈 0.01.There were no statistical differences in utilization rates of autologous blood of the two groups; the utilization rates ofallogeneic RBC, total allogeneic RBC and total RBC were 48.48%, 51.5%, and 75.7% in POTTS-E group, which were lower than those of the control group （84.3%, 84.3%, and 96.8%） P 〈 0.05 or P 〈 0.01. Per capita consumption of intraoperative allogeneic RBC. total allogeneic RBC and total RBC were 0 （0, 3.0）, 2.0 （0, 4.0）, and 3.1 （0.81, 6.0） in POTTS-E groups were all lower than those of control group （4.0 [2.0, 4.0], 4.0 [2.0, 6.0] and 5.8 [2.7, 8.2]）, P 〈 0.05 or P 〈 0.00 I. Conclusions： Peri-operative Transfilsion Trigger Score-E evaluation scheme is used to guide the application of RBC. There are no differences in the recent prognosis of patients with the traditional transfusion guidelines. This scheme is sate; Compared with doctor experience-based sub iective assessment, the scoring scheme was closer to patient physiological needs lbr transfusion and more reasonable： Utilization rate and the per capita consumption of RBC are obviously declined, which has clinical significance and is feasible. Based on the abovementioned three points, POTTS-E scores scheme is safe, reasonable, and practicable and has the value tbr carrying out multicenter and large sample clinical researches.

Experience and practice of the Emergency Operations Centerz Chinese Center for Disease Control and Prevention:a case study of response to the H7N9 outbreak

Background:Emergency Operations Center(EOC)is a place to provide response to public health emergencies.Chinese Center for Disease Control and Prevention(China CDC)'s EOC was officially established in 2016,which has been the core department for the public health emergencies and risk response.In recent years,we have been continuously improving the function of EOC through many incidents.In the study,we hope to share the construction status,operation management experience of China CDC's EOC and the response process in the human avian influenza A(H7N9)outbreak.Main text:The China CDC's EOC mainly focus on building the five core elements including sites/places and facilities,information and data,plans and procedures,training and exercises,and logistics.Based on summarizing previous emergency respons巳the China CDC's EOC established its own incident management and the standardized response procedures.The event-specific data,context-specific data and event management data could be obtained through various source.The logistics department of the EOC also provides comprehensive support.The well-trained staff is another necessary conditions for its operation.Through sharing the response process of H7N9 outbreak,it further explains the EOC's functions in the five phases of outbreak response,such as the formulation of the incident response framework,monitoring,personnel dispatch and resource mobilization.Conclusions:The EOC con tributes to faster and more efficient responses during emergencies which en able a greater reduction in morbidity and mortality.Compared with the traditional incident response process,under the command and coordination of China CDC's EOC,each group involved in the response has a clearer goal,responsibilities and tasks at each stage.Meanwhile,each group also gave full play to its own expertise and advantages.As a whole,incident response tended to be more specialized and precise,which generally improves the efficiency of incident response.However,different countries and regions have different response processes to the events.We still suggested that appropriate emerge ncy operati on plan should be made according to the complexity of in cident response in the region when constructing response mechanism,through our experience.And the China CDC's EOC is still at growing and groping phase.

面向城市公共卫生数字治理的疾病预防控制应急作业中心管理平台建设

新型冠状病毒感染疫情发生以来,以传染病暴发为主的突发公共事件对超大城市的应急响应与治理能力提出了新的要求,应急作业中心的数字化转型成为各大城市选择的应对发展方向,而数字孪生技术与城市大数据的应用为我国应急作业中心的建设提供了新的思路。以上海市数智疾控应急作业中心管理平台建设为例,总结面向城市公共卫生数字治理平台建设的规划内容与设计经验,围绕系统架构、孪生架构、业务模型阐明平台的总体架构设计,详细介绍数字业务中心、应急指挥中心、辅助作业中心、孪生服务平台四大业务平台建设内容,为我国超大城市公共卫生数字治理提供新的发展思路与实证参考。

12点调平系统及其应急预案措施

With high stability,strong bearing capacity and other characteristics,multi-point leveling systems have been widely used in various industries.The mobile platform here uses a 12-point leveling system,which is mainly composed of the mechanical transmission system of the supporting arm,a hydraulic drive system and an electrical control system.The leveling is realized through the proportional lifting of the arms in four quadrants.In order to ensure the smooth conduct of launch missions,emergency plans were made for the leveling system incase of failure of a single arm.

An evaluation of the role played by remote sensing technology following the World Trade Center attack

Remote sensing technology has been widely recognized for contributing to emergency response efforts after the World Trade Center attack on September 11th, 2001. The need to coordinate activities in the midst of a dense, yet relatively small area, made the combination of imagery and mapped data strategically useful. This paper reviews the role played by aerial photography, satellite imagery, and LIDAR data at Ground Zero. It examines how emergency managers utilized these datasets, and identifies significant problems that were encountered. It goes on to explore additional ways in which imagery could have been used, while presenting recommendations for more effective use in future disasters and Homeland Security applications. To plan adequately for future events, it was important to capture knowledge from individuals who responded to the World Trade Center attack. In recognition, interviews with key emergency management and geographic information system (GIS) personnel provide the basis of this paper. Successful techniques should not be forgotten, or serious problems dismissed. Although widely used after September 11th, it is important to recognize that with better planning, remote sensing and GIS could have played an even greater role. Together with a data acquisition timeline, an expanded discussion of these issues is available in the MCEER/NSF report “Emergency Response in the Wake of the World Trade Center Attack; The Remote Sensing Perspective” (Huyck and Adams, 2002) Keywords World Trade Center (WTC) - terrorism - emergency response - emergency management - ground zero - remote sensing - emergency operations - disasters - geographic information systems (GIS) - satellite imagery - synthetic aperture radar (SAR) - light detection and ranging imagery (LIDAR)

COVID-19疫情期间急诊手术应急预案制定与应用研究

目的探讨COVID-19疫情期间急诊手术应急预案制定与应用。方法以新冠肺炎诊疗、防控及个人防护相关规章制度及操作规范为依据,针对手术室为新冠肺炎交叉感染高风险区域的特点,结合本院实际情况,制定实施COVID-19疫情期间急诊手术应急预案,启动演练。结果2019年12月27日―2020年3月9日应急预案管理期间,成功实施手术1824例,其中,急诊手术340例,启动应急管理预案成功实施新冠肺炎疑似患者急诊手术1例;手术室全体医务人员以及同期1823例手术患者中无交叉感染病例出现。结论应急管理预案在急诊手术中的建立及应用,能够显著提升医护人员新冠肺炎疫情的危机应对、快速反应和应急防控能力,有效阻断新冠肺炎院内交叉感染,保障患者的医疗安全以及医务人员的生命健康。

Status of Severe Accident Management Guidelines at Kozloduy Nuclear Power Plant

The objective of this paper is to present the current organization of the Emergency Procedures including Emergency Operating Procedures (EOP) and Severe Accident Management Guidelines (SAMG) in Kozloduy Nuclear Power Plant (KNPP) as a function of the severity of the accident conditions. Special attention is paid to SAMG. It is described when the SAMG are used and at which conditions in a transition between the EOPs and the SAMG should be made. The Critical Safety Function Restoration Guidelines and their connections with SAMGs and EOPs are also discussed. The arrangement of SAMG is described in detail, since in the KNPP exist 2 types of SAMGs for Main Control Room (MCR) and for the Accident Management Centre (AMC) and they contain the same strategies, but they are different in format. Both types are symptom oriented procedures, but those for MCR are in 2-column-format with interconnections, whereas those for the AMC are developed in a logical manner and simplified for people, who take decisions. In the paper, they are also discussed the adopted strategies in existing SAMG that should be followed to recover from a damaged core condition and to prevent or mitigate the release of fission products. In the paper, they are also described a number of technical measures for management and mitigation of severe accidents, which are implemented in KNPP before and after the Fukushima accident. Many of them are common for WWER-1000 type of reactors, but some of them are unique and plant specific. This information can be useful for operators of other WWER type reactors or even PWR reactors.

Animal model-based simulation training for three emergent and urgent operations of penetrating thoracic injuries

Purpose:To develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees’performance for emergent and urgent thoracic surgeries.Methods:With a homemade machine,animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage,urgent sternotomy,and emergent thoracotomy.Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models.Five operation teams from basic-level hospitals(group A)and five operation teams from level III hospitals(group B)were included to be trained and tested.Testing standards for the operations were established after thorough literature review,and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards.Tests were carried out after the training.Pre-and post-training performances were compared.Post-training survey using 7-point Likert scale was taken to evaluate the feelings of the trainees to these training approaches.Results:Animal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%.After literature review,testing standards were established,and expert questionnaire results showed that the scientific score was 7.30±1.49,and the feasibility score was 7.50±0.89.Post-training performance was significantly higher in both group A and group B than pre-training performance.Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury.Conclusions:Animal model-based simulation training established in the current study could improve the trainees’performance for emergent and urgent thoracic surgeries,especially of the surgical teams from basic-level hospitals.

Surgical first aid and nursing care of a parturient with massive hemorrhage in natural delivery

Objective:To summarize the first aid and nursing of the operating room due to serious complications caused by postpartum massive bleeding.Methods:One case of emergency hemorrhage was ineffective in emergency hysterectomy.Results:The uterus was successfully removed and the bleeding was successfully stopped.It was transferred to the ICU under general anesthesia.Conclusion:For pregnant women with postpartum massive bleeding and hemorrhagic shock and diffuse intravascular coagulation(DIC),targeted surgical treatment and complete operating room emergency care are of great significance to save maternal lives.

Selected issues of cartographic communication optimization for emergency centers

Cartographic communication and support within emergency management(EM)are complicated issues with changing demands according to the incident extent and phase of the EM cycle.Keeping in mind the specifics of each purpose,it is obvious that spatial data used for maps preparation and production must be differently visualized even for the same type of emergency incident(traffic accident,fire,and natural disaster).Context-based cartography is a promising methodology to deal with the changing demands of an operational EM center.An overview of cartographic communication is presented within the context of an operational EM center,activities of particular actors,and map use supporting the incident elimination.The authors of the paper respond to a series of questions,for example:what is the current cartographic support of operational EM in the Czech Republic in Digital Earth conditions?What possibilities are there to improve the cartographic communication?How can contextual cartographic services be implemented in a Web environment and how can the usability of results be tested?The paper gives several examples of the usage of cartographic technologies in map creation for various emergency situations.