Free Content about the Zika Virus Now Available


Just 8 days after the public health emergency was declared, this content regarding the Zika virus has been written, reviewed, edited, and released as a freely available resource.

On February 1st, the World Health Organization declared a Public Health Emergency of International Concern related to clusters of microephaly cases in some areas affected by the Zika virus. Like the Ebola virus, there had been very little funding and research on Zika until the recent emergency and associated media and scientific attention – there is therefore a dearth of information and there is neither a vaccine nor prophylactic pharmacotherapy available to prevent Zika virus infection.

In response to concern over the effects of Zika virus infection in pregnant women, the medical publishing team at Cambridge University Press commissioned a brief summary of current evidence and recommendations. Just 8 days after the public health emergency was declared, this content has been written, reviewed, edited and released as a freely available resource. The content has been provided by Professor Bernard Gonik, Fann S. Srere Chair of Perinatal Medicine, Wayne State University School of Medicine.

Released in advance as a freely accessible public resource, this content is part of High-Risk Pregnancy: Management Options – a forthcoming updateable online product from Cambridge University Press. Like all of the content in High-Risk Pregnancy: Management Options, the Zika section will be regularly updated as new information arises.

Read about the Zika Virus Here



DMPHP Special Issue on Ebola

ebola blog pic
Accurate knowledge regarding Ebola is critical and pertinent for practicing physicians and clinicians given the current risk of hazardous global outbreak and epidemic. Disaster Medicine and Public Health Preparedness has launched a special issue, Ebola Virus and Public Health, to surround the public, medical professionals and media with necessary knowledge in this critical societal moment.

As part of this special issue, the journal has published A Primer on Ebola for Clinicians. The primer was prepared by Dr. Eric Toner, internist and emergency physician, as well as Amesh A. Adalja and Thomas V. Inglesby (all of the University of Pittsburgh Medical Center). The primer discusses the history, epidemiology, microbiology, clinical manifestations, biosafety, prevention, treatment and experimental vaccines to offer an informative and inclusive background on the Ebola virus for clinicians.

The scale of the uncontrolled outbreak in Western Africa makes further exportation to other parts of the world an unfortunate possibility (as citizens across the globe have already witnessed, with cases appearing in Europe and the United States). Those who serve at the frontlines of emergency medicine, critical care, infectious diseases and infection control are in high need and demand, and in some cases, high risk. The primer provided by the UPMC professionals offers clear and concise information on the fundamentals of the virus, including its diagnosis, treatment and control. The public and media are especially apt to benefit from the clear and accurate information provided by the primer, as the popularity of social media makes misinformation about Ebola easily (and rapidly) sharable, believed and misattributed.

The DMPHP Special Edition on Ebola has been designed from the outset to be a conduit for operational and policy level information that will improve outcomes and decision making, and to ensure that this information is available to all practitioners.

As such, published contributions will go online immediately after appropriate review and placed chronologically to ensure a ready historical track for future review and debate. The Special Edition will be made available to everyone in the field as well as at the policy level decision makers worldwide.

View the special issue contents here free of charge. More articles will be added as soon as they become available online.

The SDMPH have released press releases on some of these papers- you can view these by using the links below:

Volunteer guidelines for clinicians in the ebola epidemic
A Primer on Ebola for Clinicians
Special issue on Ebola



Taking on Tornadoes: Twitter and Dual-pol radar join forces

An article published in Disaster Medicine and Public Health Preparedness has revealed that the combined use of Dual-Pol radar and Twitter has the potential to significantly improve outcomes in communities faced with tornadic activity.

On February 10, 2013, at approximately 5:00 PM, an EF-4 tornado* with sustained maximum winds of 170 mph struck Hattiesburg, Mississippi, a small city with a population of approximately 45 000 residents. The tornado traversed densely inhabited areas including residential homes, businesses, and a large state university, causing $40 million in damage and resulting in 50 reported injuries and no fatalities.

For the first time in the Hattiesburg area, new weather technologies, such as the dual-polarization radar+, combined with the social media entity Twitter were used in a concerted effort to mitigate morbidity and mortality. The article analyzed the combined use of these technologies in preventing injury and death during a violent storm.

Several notable organizations used Twitter during the tornadic events in February. These organizations included the NWS in Jackson, Mississippi (@NWSJacksonMS), the Weather Channel (@weatherchannel), the Sun Herald newspaper (@SunHerald), and WDAM News, Talk and Radio, a local organization (@WDAM).

Twitter users followed weather-related handles for up-to-the-minute information regarding current weather conditions in areas where they maintain community ties. While not always current, the information is disseminated to the public quickly, especially in the event of severe weather in an area that may experience loss of power and Internet service. In this instance, smart phones with high-speed networks, which are owned by more than half of all adults in the United States, may still be able to receive texts and tweets regarding the severe weather.

Twitter users and storm chasers used the terminology from the NWS warnings to inform the public about the severity of this tornado. Along with the strong wording in the tornado warnings issued, the Weather Channel used tweets to describe the specific direction of the tornado, as indicated by radar and storm spotters on the ground. Twitter users in the Hattiesburg community were alerted to the specific location of the tornado and were then able to judge the safety of their current location. The use of the phrase tornado emergency as part of the NWS alerts and tweets also likely raised the alert in communities. Tornado emergency is a phrase that was instated by the NWS in 2005 to alert highly populated areas of a tornado on the ground that is expected to continue to produce a high magnitude of damage along its path coupled with the high likelihood of numerous fatalities.

The danger associated with the tornadic storms in the Hattiesburg area was highlighted with the issued tornado emergency. This type of alert has only been issued a total of 13 times in Mississippi since 2005. These notifications were frequently tweeted by the NWS handles, and were subsequently retweeted. These transmissions enabled the communique to go viral, or to be transmitted exponentially. One of those tweets that mentioned the phrase tornado emergency was retweeted 19 times.

This study revealed that the combined use of Dual-Pol radar and Twitter has the potential to significantly improve outcomes in communities faced with tornadic activity.

The average warning time preceding a tornado is 13 minutes. With the use of Dual-Pol radar, the tornado warning time was 30 minutes in advance of the storm that occurred on February 10, 2013. The dramatic increase in warning time provided local citizens ample time to reach a safe location, and likely was a major factor in the absence of fatalities and critical injuries.

Italo Subbarao DO, MBA, one of the authors of the paper commented, “While we recognize that other forms of risk communication such as television, radio, and other social media outlets were used during the tornado, we believe that Twitter was the most efficiently designed method for communication, particularly with the ubiquitous use of smart phones. This method of risk communication was useful for the public, emergency management, and health care providers to identify the severity of the impending tornado.

“Given the scope of damage sustained, it is no small wonder that fatalities were avoided altogether. The advent of more accurate weather-sensing technologies coupled with the adoption of more recent social media communication channels such as Twitter may serve as an effective early warning system in regions routinely experiencing high frequency of tornadic activity and should be further explored.”

* Tornadoes are severe wind storms that are characterized by a violently rotating column of air that reaches the ground. Tornadoes are classified using the enhanced Fujita (EF) scale, which rates the intensity based on resultant structural damage. A rating of EF-0 is the weakest, with estimated wind speeds of 65 to 85 mph; and EF-5 is the strongest, with sustained winds exceeding 200 mph. During an average year, only 2% of tornadoes are categorized as violent, with ratings of EF-3 and above. Nearly 1000 tornadoes occur in the United States every year and account for an average of 87 fatalities and 1500 injuries.

Mississippi experiences an average of 2 EF-3 or stronger tornadoes per year, with an average of 3 tornadoes of any strength occurring in February.

+ In January, 2013, the NWS (National Weather Service) in Jackson, Mississippi, completed a $225 000 radar upgrade from the traditional Doppler radar to the new dual-polarization radar (Dual-Pol radar).

Impact of Dual-Polarization Radar Technology and Twitter on the Hattiesburg, Mississippi Tornado, Italo Subbarao et al.  is published online and in print in Disaster Medicine and Public Health Preparedness and can be viewed free of charge for a limited time here.

Ethics and force-feeding prisoners on hunger strike « Medicine « Cambridge Journals Blog

Health Professionals Who Participate in Force-feeding Prisoners on Hunger Strike at Guantanamo Bay Should Lose Professional Licenses

Force-feeding Violates Medical Ethics and Amounts to Torture

Physicians and other licensed health professionals are force-feeding hunger strikers held prisoner at the US Naval Base at Guantanamo Bay (GTMO), Cuba. These health professionals are violating the medical ethics they swore to uphold and are complicit in torture, according to the authors of an article published in Prehospital and Disaster Medicine. Dr. Jennifer Leaning, Director of the FXB Center for Health and Human Rights at Harvard University, and her Harvard colleagues, Sarah Dougherty, Dr. Gregg Greenough, and Dr. Frederick Burkle, urge the licenses of health professionals who participate in force-feeding be revoked. Leaning and her co-authors also call for the medical profession to demand changes in military medical management protocols and stronger protections for military health professionals who protest unethical orders.

Historically, the treatment of hunger strikers has been difficult for health professionals, particularly those employed in institutional settings, because the practice raises profound clinical, ethical, moral, humanitarian and legal questions.

Leaning and her co-authors note that hunger strikes are political acts, not medical conditions. Hunger strikers refuse food on a voluntary, informed basis and without suicidal intent. At GTMO and elsewhere, force-feeding involves the use of force and physical restraints to immobilize hunger strikers without their consent and against their express wishes—actions which constitute battery and violate basic human dignity. The US Department of Defense (DoD) force-feeding policy and protocols are a “gross violation” of US and international ethical standards prohibiting force-feeding of hunger strikers.

The DoD has also ratified the practice through a longstanding policy of vetting health professionals assigned to GTMO. Military health care providers have the same medical ethics obligations as civilian providers, but as military personnel are also required to obey lawful orders. Because force-feeding has been found lawful under US civilian and military law, military health professionals at GTMO ordered to force-feed hunger strikers must choose between upholding medical ethics and obeying the law.

“Given the failure of civilian and military law to end force-feeding, the medical profession must exert policy and regulatory pressure to bring DoD policy and operations into compliance with established ethical standards,” says Jennifer Leaning. “We join those medical and ethical authorities who have called for investigations into the force-feeding at GTMO and for sanctions where appropriate. This paper is the first in the medical literature to review the history of exhausting attempts at remedy through US law and presents the tight argument for why only the US medical profession can adequately uphold professional standards of medical ethics through its licensing power. When the law has become deferential to the claims of civilian and military institutions, our only ethical bastion as physicians and health care providers is the national and international guild we have built and belong to. The professional battle to uphold principles of medical ethics and human rights has often in the past proved grossly feeble against prevailing institutional pressures. We turn away from this instance at our collective peril.”

“Political events and actions are increasingly forcing physicians and other health care professionals to choose between medical ethics and US law,” says Dr. Samuel J. Stratton, Editor-in-Chief of Prehospital and Disaster Medicine. “In both military and civilian contexts, the issues surrounding force-feeding are complex and contentious, and should be subject to rigorous examination and debate. Prehospital and Disaster Medicine intends to publish additional papers adding to the debate on how health professionals should navigate this important ethical dilemma.”


The paper “Hunger Strikers: Ethical and Legal Dimensions of Medical Complicity in Torture at Guantanamo Bay” can be viewed free of charge for a limited time here.

A companion paper, providing historical perspective from the emergency management of refugee camp asylum seekers, can also be viewed free of charge for a limited time here.


via Ethics and force-feeding prisoners on hunger strike « Medicine « Cambridge Journals Blog.

Treating radiation injuries in US travelers returning from Japan

March 22, 2011 — In response to the crisis in Japan, the US Centers for Disease Control and Prevention (CDC) hosted a conference call for clinicians to answer questions about treating radiation injuries in US travelers returning from Japan.

During the hour-long Clinician Outreach and Communication Activity call yesterday evening, Jeffrey Nemhauser, MD, who is a captain in the US Public Health Service and a medical officer in the CDC’s Radiation Studies Branch, answered questions from healthcare providers about radiation exposure and treatment.

Dr. Nemhauser stressed that the CDC is not aware of any US travelers returning from Japan who have been “contaminated with material at a level of concern.” If a traveler is contaminated, the CDC will recommend decontamination, collect data, and follow-up with the traveler, he said.

Customs officials routinely screen travelers (and their luggage) entering the United States for radiation contamination, he said. Because of the radiation leaks in Japan, however, the CDC is creating extra screening protocols for airports. Dr. Nemhauser said that these protocols should go into effect this week. Read more of this post

Medical Resources Strained in Japan

 March 17, 2011 — The devastating magnitude 9.0 earthquake and tsunami that occurred in Japan’s Miyagi prefecture on March 11 have caused a cascade of health and safety problems for survivors, including possible exposure to radiation from the region’s damaged Fukushima Daiichi nuclear plant. The disaster has strained medical resources on the ground, but it is unclear how many resources will be needed in the future.

“This is a very complex disaster, and it’s an evolving, ongoing situation,” Kristi L. Koenig, MD, director of the Center for Disaster Medical Sciences at the University of California–Irvine, told Medscape Medical News.

“The recovery phase of this disaster is going to be years and years and years,” she said. “They need people over the next many months to years to help, because the whole public health infrastructure is disrupted.”

Japan’s experience has been very different from Haiti, where a magnitude 7.0 earthquake struck in January 2010 and created a vast need for medical help. “In Haiti, the existing healthcare infrastructure was basically nonexistent,” Dr. Koenig said, “and the building codes for earthquakes were not anywhere near what they are in Japan.”

Unlike Haiti, Japan has well-organized civil defense teams that helped victims immediately until outside help was available, Dr. Koenig pointed out. These factors likely mitigated the injuries and deaths from the earthquake in Japan.

“Japan has significant emergency management capacity — one of the best in the world,” Margaret Aguirre, director of global communications for the International Medical Corps, told Medscape Medical News in an email.

Future Clinical Assistance May Be Needed Read more of this post

Disaster Medicine Core Competencies for Emergency Physicians, Nurses and EMTs

Blog Post by Carl H. Schultz, MD, Professor of Emergency Medicine

The specialty of disaster medicine continues to grow and mature.  Journals dedicated to this field of study as well as textbooks now exist.  In fact, ACEP has recently endorsed a new reference text published by Cambridge University Press entitled Koenig and Schultz’s Disaster Medicine:  Comprehensive Principles and Practices.  Ideally, this body of scientific data would lead to development of a standard set of clinical competencies for those involved in the initial evaluation and treatment of disaster victims.  This is needed to ensure that effective emergency medical response can be provided efficiently during all types of disaster events.  Creation of broadly-recognized standard core competencies to support development of disaster response education and training for specific healthcare professionals will help to ensure that medical personnel are truly prepared to care for victims of mass casualties.  Nonetheless, a widely supported standardized set of core competencies for emergency physicians, nurses, and pre-hospital EMS personnel is currently lacking. 

Read more of this post

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