A health care emergency preparedness coalition (coalition) is a group of health care organizations, public safety agencies, and public health partners that join forces for the common cause of making their communities safer, healthier, and more resilient. Coalitions have been characterized as being focused on hospital systems instead of the health care of the community as a whole. We discuss 2 examples of coalition partners that use a more inclusive approach to planning, response, and recovery. The first is a large health care system spread across 23 states, and the other is a public safety agency in northeast Pennsylvania that took the lead to address the preparedness and response toward a large influx of burn patients and grew to encompass all aspects of community health care. (Disaster Med Public Health Preparedness. 2015;9:712–716)

As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population’s health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented. (Disaster Med Public Health Preparedness. 2015;9:558–567)

During an evolving public health emergency, a simple algorithm for initial patient identification and management is essential for providers on the front lines. This article recommends a 3-pronged system of Identify, Isolate, Inform to describe the actions necessary in the first few minutes of encountering a potential Ebola patient. Application of the “vital sign zero” triage concept of early recognition of potential threats coupled with this novel algorithm will optimize protection of health care workers and the public health while concurrently providing a safe method for individual patient care. (Disaster Med Public Health Preparedness. 2014;0:1-2)

The current Ebola outbreak is the worst global public health emergency of our generation, and our global health care community must and will rise to serve those affected. Aid organizations participating in the Ebola response must carefully plan to carry out their responsibility to ensure the health, safety, and security of their responders. At the same time, individual health care workers and their employers must evaluate the ability of an aid organization to protect its workers in the complex environment of this unheralded Ebola outbreak. We present a minimum set of operational standards developed by a consortium of Boston-based hospitals that a professional organization should have in place to ensure the health, safety, and security of its staff in response to the Ebola virus disease outbreak. (Disaster Med Public Health Preparedness. 2014;0:1-2)

The US health care system has maintained an objective of preparedness for natural or manmade catastrophic events as part of its larger charge to deliver health services for the American population. In 2002, support for hospital-based preparedness activities was bolstered by the creation of the National Bioterrorism Hospital Preparedness Program, now called the Hospital Preparedness Program, in the US Department of Health and Human Services. Since 2012, this program has promoted linking health care facilities into health care coalitions that build key preparedness and emergency response capabilities. Recognizing that well-functioning health care coalitions can have a positive impact on the health outcomes of the populations they serve, this article informs efforts to optimize health care coalition activity. We first review the landscape of health care coalitions in the United States. Then, using principles from supply chain management and high-reliability organization theory, we present 2 frameworks extending beyond the Office of the Assistant Secretary for Preparedness and Response’s current guidance in a way that may help health care coalition leaders gain conceptual insight into how different enterprises achieve similar ends relevant to emergency response. We conclude with a proposed research agenda to advance understanding of how coalitions can contribute to the day-to-day functioning of health care systems and disaster preparedness. (Disaster Med Public Health Preparedness. 2015;9:717–723)

If the Ebola tragedy of West Africa has taught us anything, it should be that the 2005 International Health Regulations (IHR) Treaty, which gave unprecedented authority to the World Health Organization (WHO) to provide global public health security during public health emergencies of international concern, has fallen severely short of its original goal. After encouraging successes with the 2003 severe acute respiratory syndrome (SARS) pandemic, the intent of the legally binding Treaty to improve the capacity of all countries to detect, assess, notify, and respond to public health threats has shamefully lapsed. Despite the granting of 2-year extensions in 2012 to countries to meet core surveillance and response requirements, less than 20% of countries have complied. Today it is not realistic to expect that these gaps will be solved or narrowed in the foreseeable future by the IHR or the WHO alone under current provisions. The unfortunate failures that culminated in an inadequate response to the Ebola epidemic in West Africa are multifactorial, including funding, staffing, and poor leadership decisions, but all are reversible. A rush by the Global Health Security Agenda partners to fill critical gaps in administrative and operational areas has been crucial in the short term, but questions remain as to the real priorities of the G20 as time elapses and critical gaps in public health protections and infrastructure take precedence over the economic and security needs of the developed world. The response from the Global Outbreak Alert and Response Network and foreign medical teams to Ebola proved indispensable to global health security, but both deserve stronger strategic capacity support and institutional status under the WHO leadership granted by the IHR Treaty. Treaties are the most successful means the world has in preventing, preparing for, and controlling epidemics in an increasingly globalized world. Other options are not sustainable. Given the gravity of ongoing failed treaty management, the slow and incomplete process of reform, the magnitude and complexity of infectious disease outbreaks, and the rising severity of public health emergencies, a recommitment must be made to complete and restore the original mandates as a collaborative and coordinated global network responsibility, not one left to the actions of individual countries. The bottom line is that the global community can no longer tolerate an ineffectual and passive international response system. As such, this Treaty has the potential to become one of the most effective treaties for crisis response and risk reduction worldwide. Practitioners and health decision-makers worldwide must break their silence and advocate for a stronger Treaty and a return of WHO authority. (Disaster Med Public Health Preparedness. 2015;9:568–580)

On September 16, 2014, President Obama, speaking from the Centers for Disease Control and Prevention in Atlanta, Georgia, declared the Ebola epidemic in West Africa a national security priority and laid out the US government’s plan for contributing to and helping to lead the international response. There were, and remain, several facets to the US government’s efforts to help control the epidemic, including the commitment to provide a facility and staffing in Liberia that would ensure access to a high level of quality care for any Liberian or international health care workers who may, themselves, become infected and ill with Ebola. That facility came to be known as the Monrovia Medical Unit and is staffed by officers of the US Public Health Service. The following pages are excerpts from the journal I kept during my time at the Monrovia Medical Unit, which I hope will relate some elements of the concerted effort that took place that led to this arm of the US government response being established. (Disaster Med Public Health Preparedness. 2015;9:581–585)

The unprecedented Ebola Virus Disease (EVD) outbreak in West Africa, with its first cases documented in March 2014, has claimed the lives of thousands of people, and it has devastated the health care infrastructure and workforce in affected countries. Throughout this outbreak, there has been a critical lack of health care workers (HCW), including physicians, nurses, and other essential non-clinical staff, who have been needed, in most of the affected countries, to support the medical response to EVD, to attend to the health care needs of the population overall, and to be trained effectively in infection protection and control. This lack of sufficient and qualified HCW is due in large part to three factors: 1) limited HCW staff prior to the outbreak, 2) disproportionate illness and death among HCWs caused by EVD directly, and 3) valid concerns about personal safety among international HCWs who are considering responding to the affected areas. These guidelines are meant to inform institutions who deploy professional HCWs. (Disaster Med Public Health Preparedness. 2015;9:586–590)

Patients with suspected public health threats, such as Ebola, must be quickly identified and isolated on presentation to health care facilities. Patients can be screened by intake staff or other health care providers; however, perfect compliance is difficult to achieve. Well-designed, carefully placed clinical decision support (CDS) within the electronic health record can be a reliable partner in helping to rapidly identify, isolate, and care for patients with suspected Ebola infection and other emerging public health threats. We describe how different types of CDS can be applied in the clinical workflow and share how we implemented CDS to force Ebola screening upon patient presentation to our emergency department. (Disaster Med Public Health Preparedness. 2015;9:591–594)

The last 14 years has taught us that that we are facing a new reality; a reality in which public health emergencies are a common occurrence. Today, we live in a world with dangerous people without state sponsorship who are an enormous threat to our safety; one where emerging and reemerging infectious diseases are waiting to break out; a world where the benefits of globalization in trade, transportation, and social media brings threats to our communities faster and with a greater risk than ever before. Even climate change has entered into the preparedness equation, bringing with it the forces of nature in the form of extreme weather and its complications. (Disaster Med Public Health Preparedness. 2015;9:728–729)