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BT 15.000 718.042 Td /F2 21.0 Tf  [(Developing a Health System Approach to Disaster )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Management: A Qualitative Analysis of the Core Literature to )] TJ ET
BT 15.000 668.146 Td /F2 21.0 Tf  [(Complement the WHO Toolkit for Assessing Health-System )] TJ ET
BT 15.000 643.198 Td /F2 21.0 Tf  [(Capacity for Crisis Management)] TJ ET
Q
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BT 15.000 625.192 Td /F3 9.8 Tf  [(August 22, 2012)] TJ ET
BT 83.523 625.192 Td /F3 9.8 Tf  [(�)] TJ ET
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BT 88.398 625.192 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 613.351 Td /F1 9.8 Tf  [(Dr Claire Bayntun)] TJ ET
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BT 103.187 613.351 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 108.608 613.351 Td /F1 9.8 Tf  [(Gerald Rockenschaub)] TJ ET
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BT 205.065 613.351 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 210.486 613.351 Td /F1 9.8 Tf  [(Virginia Murray)] TJ ET
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BT 26.250 601.446 Td /F1 9.8 Tf  [(Bayntun C, Rockenschaub G, Murray V. Developing a Health System Approach to Disaster Management: A Qualitative )] TJ ET
BT 542.132 601.446 Td /F1 9.8 Tf  [(Analysis )] TJ ET
BT 26.250 589.542 Td /F1 9.8 Tf  [(of the Core Literature to Complement the WHO Toolkit for Assessing Health-System Capacity for Crisis Management. PLOS )] TJ ET
BT 26.250 577.637 Td /F1 9.8 Tf  [(Currents Disasters. 2012 Aug 22 . Edition 1. doi: 10.1371/5028b6037259a.)] TJ ET
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BT 26.250 548.534 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 528.580 Td /F1 9.8 Tf  [(BACKGROUND The World Health Organisation�s \(WHO\) sixty-fourth World Health Assembly in May 2011 adopted a resolution )] TJ ET
BT 26.250 516.675 Td /F1 9.8 Tf  [(on �strengthening national health emergency and disaster management capacities and resilience of health systems�. Disaster )] TJ ET
BT 26.250 504.771 Td /F1 9.8 Tf  [(management is a topical issue globally and countries are being encouraged to improve their disaster preparedness, along with )] TJ ET
BT 26.250 492.866 Td /F1 9.8 Tf  [(growing international commitment to strengthening health systems. Lessons identified from disasters have not been effectively )] TJ ET
BT 26.250 480.961 Td /F1 9.8 Tf  [(collated; essential experience is forgotten.)] TJ ET
BT 26.250 461.556 Td /F1 9.8 Tf  [(METHODS This paper describes the analysis of the worldwide experience of disasters through a health systems approach. A )] TJ ET
BT 26.250 449.652 Td /F1 9.8 Tf  [(systematic search of the core literature from January 2000 to November 2011 was conducted. Components drawn from the )] TJ ET
BT 26.250 437.747 Td /F1 9.8 Tf  [(WHO�s Global assessment of national health sector emergency preparedness and response baseline survey were combined )] TJ ET
BT 26.250 425.842 Td /F1 9.8 Tf  [(with WHO�s six health system building blocks \(or levers\) to act as the initial analysis anchors, with a further grounded theory )] TJ ET
BT 26.250 413.937 Td /F1 9.8 Tf  [(qualitative analysis of the literature allowing the identification of emerging themes and insights. The priority areas identified by )] TJ ET
BT 26.250 402.033 Td /F1 9.8 Tf  [(this literature review were then compared with the topics covered by the new expert-consensus-derived Toolkit for assessing )] TJ ET
BT 26.250 390.128 Td /F1 9.8 Tf  [(health-system capacity for crisis management developed by the WHO Regional Office for Europe.)] TJ ET
BT 26.250 370.723 Td /F1 9.8 Tf  [(FINDINGS 143 publications identified from a literature search were analysed and appraised. Themes and examples from the )] TJ ET
BT 26.250 358.818 Td /F1 9.8 Tf  [(literature demonstrate how health system strengthening should contribute to disaster management. Priority areas under-)] TJ ET
BT 26.250 346.914 Td /F1 9.8 Tf  [(represented in the WHO Toolkit and identified by the qualitative analysis are discussed.)] TJ ET
BT 26.250 327.509 Td /F1 9.8 Tf  [(INTERPRETATION Collation and analysis of the disaster management literature identifies how health system strengthening can )] TJ ET
BT 26.250 315.604 Td /F1 9.8 Tf  [(promote resilience and efficient recovery in the face of disasters. These findings support and complement the WHO Toolkit. )] TJ ET
BT 26.250 303.699 Td /F1 9.8 Tf  [(Countries can use the literature evidence with the WHO Toolkit to assess their disaster management capacities and identify )] TJ ET
BT 26.250 291.795 Td /F1 9.8 Tf  [(priorities for strengthening their health system.)] TJ ET
BT 26.250 272.390 Td /F1 9.8 Tf  [(Citation: Bayntun C, Rockenschaub G, Murray V. Developing a health system approach to disaster management: A qualitative )] TJ ET
BT 26.250 260.485 Td /F1 9.8 Tf  [(analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management. )] TJ ET
BT 26.250 248.580 Td /F1 9.8 Tf  [(PLOS Currents Disasters. 2012 Aug 22. doi: 10.1371/5028b6037259a.)] TJ ET
BT 26.250 211.978 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 192.024 Td /F1 9.8 Tf  [(Are we prepared for disasters?)] TJ ET
BT 26.250 172.619 Td /F1 9.8 Tf  [(Each disaster and its context are different, yet many share similar health sector vulnerabilities and thus common disaster )] TJ ET
BT 26.250 160.714 Td /F1 9.8 Tf  [(management practices and policies can be built in to the health system to create resilience � the �all-hazards� approach. Four )] TJ ET
BT 26.250 148.809 Td /F1 9.8 Tf  [(recent major disasters exemplify the need for strengthened health systems.)] TJ ET
BT 26.250 129.405 Td /F1 9.8 Tf  [(The earthquake in Haiti, 12)] TJ ET
BT 143.308 133.293 Td /F1 8.7 Tf  [(th)] TJ ET
BT 150.537 129.405 Td /F1 9.8 Tf  [( Jan 2010, left 1.5 million homeless and killed 149,095 people of which 6300 died in a potentially )] TJ ET
BT 26.250 117.500 Td /F1 9.8 Tf  [(preventable cholera outbreak which infected a further 450,000 residents.)] TJ ET
0.267 0.267 0.267 rg
BT 338.952 119.007 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 343.771 117.500 Td /F1 9.8 Tf  [( Haiti lacked an effective health system prior to the )] TJ ET
BT 26.250 105.595 Td /F1 9.8 Tf  [(earthquake and national authorities were not equipped to manage relief or recovery priorities when the disaster occurred.)] TJ ET
0.267 0.267 0.267 rg
BT 547.573 107.102 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 93.690 Td /F1 9.8 Tf  [(Governance structures were destroyed and the required services, health workers, surveillance, resources, funding and )] TJ ET
BT 26.250 81.786 Td /F1 9.8 Tf  [(\(attempts at\) coordination were provided almost completely by international organisations, creating its own set of complications )] TJ ET
BT 26.250 69.881 Td /F1 9.8 Tf  [(and delaying investments into the health system.)] TJ ET
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BT 236.518 71.388 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 50.476 Td /F1 9.8 Tf  [(Floods in Pakistan, July to August 2010, affected 20 million people and destroyed health facilities. In spite of the public health )] TJ ET
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BT 15.000 718.042 Td /F2 21.0 Tf  [(Developing a Health System Approach to Disaster )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Management: A Qualitative Analysis of the Core Literature to )] TJ ET
BT 15.000 668.146 Td /F2 21.0 Tf  [(Complement the WHO Toolkit for Assessing Health-System )] TJ ET
BT 15.000 643.198 Td /F2 21.0 Tf  [(Capacity for Crisis Management)] TJ ET
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BT 15.000 625.192 Td /F3 9.8 Tf  [(August 22, 2012)] TJ ET
BT 83.523 625.192 Td /F3 9.8 Tf  [(�)] TJ ET
0.267 0.267 0.267 rg
BT 88.398 625.192 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 613.351 Td /F1 9.8 Tf  [(Dr Claire Bayntun)] TJ ET
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BT 103.187 613.351 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 108.608 613.351 Td /F1 9.8 Tf  [(Gerald Rockenschaub)] TJ ET
0.271 0.267 0.267 rg
BT 205.065 613.351 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 210.486 613.351 Td /F1 9.8 Tf  [(Virginia Murray)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 601.446 Td /F1 9.8 Tf  [(Bayntun C, Rockenschaub G, Murray V. Developing a Health System Approach to Disaster Management: A Qualitative )] TJ ET
BT 542.132 601.446 Td /F1 9.8 Tf  [(Analysis )] TJ ET
BT 26.250 589.542 Td /F1 9.8 Tf  [(of the Core Literature to Complement the WHO Toolkit for Assessing Health-System Capacity for Crisis Management. PLOS )] TJ ET
BT 26.250 577.637 Td /F1 9.8 Tf  [(Currents Disasters. 2012 Aug 22 . Edition 1. doi: 10.1371/5028b6037259a.)] TJ ET
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15.000 24.286 577.500 550.970 re W n
0.271 0.267 0.267 rg
BT 26.250 548.534 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 528.580 Td /F1 9.8 Tf  [(BACKGROUND The World Health Organisation�s \(WHO\) sixty-fourth World Health Assembly in May 2011 adopted a resolution )] TJ ET
BT 26.250 516.675 Td /F1 9.8 Tf  [(on �strengthening national health emergency and disaster management capacities and resilience of health systems�. Disaster )] TJ ET
BT 26.250 504.771 Td /F1 9.8 Tf  [(management is a topical issue globally and countries are being encouraged to improve their disaster preparedness, along with )] TJ ET
BT 26.250 492.866 Td /F1 9.8 Tf  [(growing international commitment to strengthening health systems. Lessons identified from disasters have not been effectively )] TJ ET
BT 26.250 480.961 Td /F1 9.8 Tf  [(collated; essential experience is forgotten.)] TJ ET
BT 26.250 461.556 Td /F1 9.8 Tf  [(METHODS This paper describes the analysis of the worldwide experience of disasters through a health systems approach. A )] TJ ET
BT 26.250 449.652 Td /F1 9.8 Tf  [(systematic search of the core literature from January 2000 to November 2011 was conducted. Components drawn from the )] TJ ET
BT 26.250 437.747 Td /F1 9.8 Tf  [(WHO�s Global assessment of national health sector emergency preparedness and response baseline survey were combined )] TJ ET
BT 26.250 425.842 Td /F1 9.8 Tf  [(with WHO�s six health system building blocks \(or levers\) to act as the initial analysis anchors, with a further grounded theory )] TJ ET
BT 26.250 413.937 Td /F1 9.8 Tf  [(qualitative analysis of the literature allowing the identification of emerging themes and insights. The priority areas identified by )] TJ ET
BT 26.250 402.033 Td /F1 9.8 Tf  [(this literature review were then compared with the topics covered by the new expert-consensus-derived Toolkit for assessing )] TJ ET
BT 26.250 390.128 Td /F1 9.8 Tf  [(health-system capacity for crisis management developed by the WHO Regional Office for Europe.)] TJ ET
BT 26.250 370.723 Td /F1 9.8 Tf  [(FINDINGS 143 publications identified from a literature search were analysed and appraised. Themes and examples from the )] TJ ET
BT 26.250 358.818 Td /F1 9.8 Tf  [(literature demonstrate how health system strengthening should contribute to disaster management. Priority areas under-)] TJ ET
BT 26.250 346.914 Td /F1 9.8 Tf  [(represented in the WHO Toolkit and identified by the qualitative analysis are discussed.)] TJ ET
BT 26.250 327.509 Td /F1 9.8 Tf  [(INTERPRETATION Collation and analysis of the disaster management literature identifies how health system strengthening can )] TJ ET
BT 26.250 315.604 Td /F1 9.8 Tf  [(promote resilience and efficient recovery in the face of disasters. These findings support and complement the WHO Toolkit. )] TJ ET
BT 26.250 303.699 Td /F1 9.8 Tf  [(Countries can use the literature evidence with the WHO Toolkit to assess their disaster management capacities and identify )] TJ ET
BT 26.250 291.795 Td /F1 9.8 Tf  [(priorities for strengthening their health system.)] TJ ET
BT 26.250 272.390 Td /F1 9.8 Tf  [(Citation: Bayntun C, Rockenschaub G, Murray V. Developing a health system approach to disaster management: A qualitative )] TJ ET
BT 26.250 260.485 Td /F1 9.8 Tf  [(analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management. )] TJ ET
BT 26.250 248.580 Td /F1 9.8 Tf  [(PLOS Currents Disasters. 2012 Aug 22. doi: 10.1371/5028b6037259a.)] TJ ET
BT 26.250 211.978 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 192.024 Td /F1 9.8 Tf  [(Are we prepared for disasters?)] TJ ET
BT 26.250 172.619 Td /F1 9.8 Tf  [(Each disaster and its context are different, yet many share similar health sector vulnerabilities and thus common disaster )] TJ ET
BT 26.250 160.714 Td /F1 9.8 Tf  [(management practices and policies can be built in to the health system to create resilience � the �all-hazards� approach. Four )] TJ ET
BT 26.250 148.809 Td /F1 9.8 Tf  [(recent major disasters exemplify the need for strengthened health systems.)] TJ ET
BT 26.250 129.405 Td /F1 9.8 Tf  [(The earthquake in Haiti, 12)] TJ ET
BT 143.308 133.293 Td /F1 8.7 Tf  [(th)] TJ ET
BT 150.537 129.405 Td /F1 9.8 Tf  [( Jan 2010, left 1.5 million homeless and killed 149,095 people of which 6300 died in a potentially )] TJ ET
BT 26.250 117.500 Td /F1 9.8 Tf  [(preventable cholera outbreak which infected a further 450,000 residents.)] TJ ET
0.267 0.267 0.267 rg
BT 338.952 119.007 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 343.771 117.500 Td /F1 9.8 Tf  [( Haiti lacked an effective health system prior to the )] TJ ET
BT 26.250 105.595 Td /F1 9.8 Tf  [(earthquake and national authorities were not equipped to manage relief or recovery priorities when the disaster occurred.)] TJ ET
0.267 0.267 0.267 rg
BT 547.573 107.102 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 93.690 Td /F1 9.8 Tf  [(Governance structures were destroyed and the required services, health workers, surveillance, resources, funding and )] TJ ET
BT 26.250 81.786 Td /F1 9.8 Tf  [(\(attempts at\) coordination were provided almost completely by international organisations, creating its own set of complications )] TJ ET
BT 26.250 69.881 Td /F1 9.8 Tf  [(and delaying investments into the health system.)] TJ ET
0.267 0.267 0.267 rg
BT 236.518 71.388 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 50.476 Td /F1 9.8 Tf  [(Floods in Pakistan, July to August 2010, affected 20 million people and destroyed health facilities. In spite of the public health )] TJ ET
BT 26.250 38.571 Td /F1 9.8 Tf  [(challenges, previous disaster management investment in southern Punjab region allowed for effective evacuations and saved )] TJ ET
Q
q
15.000 634.458 577.500 103.542 re W n
0.267 0.267 0.267 rg
BT 15.000 718.042 Td /F2 21.0 Tf  [(Developing a Health System Approach to Disaster )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Management: A Qualitative Analysis of the Core Literature to )] TJ ET
BT 15.000 668.146 Td /F2 21.0 Tf  [(Complement the WHO Toolkit for Assessing Health-System )] TJ ET
BT 15.000 643.198 Td /F2 21.0 Tf  [(Capacity for Crisis Management)] TJ ET
Q
0.271 0.267 0.267 rg
BT 15.000 625.192 Td /F3 9.8 Tf  [(August 22, 2012)] TJ ET
BT 83.523 625.192 Td /F3 9.8 Tf  [(�)] TJ ET
0.267 0.267 0.267 rg
BT 88.398 625.192 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 613.351 Td /F1 9.8 Tf  [(Dr Claire Bayntun)] TJ ET
0.271 0.267 0.267 rg
BT 103.187 613.351 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 108.608 613.351 Td /F1 9.8 Tf  [(Gerald Rockenschaub)] TJ ET
0.271 0.267 0.267 rg
BT 205.065 613.351 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 210.486 613.351 Td /F1 9.8 Tf  [(Virginia Murray)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 601.446 Td /F1 9.8 Tf  [(Bayntun C, Rockenschaub G, Murray V. Developing a Health System Approach to Disaster Management: A Qualitative )] TJ ET
BT 542.132 601.446 Td /F1 9.8 Tf  [(Analysis )] TJ ET
BT 26.250 589.542 Td /F1 9.8 Tf  [(of the Core Literature to Complement the WHO Toolkit for Assessing Health-System Capacity for Crisis Management. PLOS )] TJ ET
BT 26.250 577.637 Td /F1 9.8 Tf  [(Currents Disasters. 2012 Aug 22 . Edition 1. doi: 10.1371/5028b6037259a.)] TJ ET
q
15.000 24.286 577.500 550.970 re W n
0.271 0.267 0.267 rg
BT 26.250 548.534 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 528.580 Td /F1 9.8 Tf  [(BACKGROUND The World Health Organisation�s \(WHO\) sixty-fourth World Health Assembly in May 2011 adopted a resolution )] TJ ET
BT 26.250 516.675 Td /F1 9.8 Tf  [(on �strengthening national health emergency and disaster management capacities and resilience of health systems�. Disaster )] TJ ET
BT 26.250 504.771 Td /F1 9.8 Tf  [(management is a topical issue globally and countries are being encouraged to improve their disaster preparedness, along with )] TJ ET
BT 26.250 492.866 Td /F1 9.8 Tf  [(growing international commitment to strengthening health systems. Lessons identified from disasters have not been effectively )] TJ ET
BT 26.250 480.961 Td /F1 9.8 Tf  [(collated; essential experience is forgotten.)] TJ ET
BT 26.250 461.556 Td /F1 9.8 Tf  [(METHODS This paper describes the analysis of the worldwide experience of disasters through a health systems approach. A )] TJ ET
BT 26.250 449.652 Td /F1 9.8 Tf  [(systematic search of the core literature from January 2000 to November 2011 was conducted. Components drawn from the )] TJ ET
BT 26.250 437.747 Td /F1 9.8 Tf  [(WHO�s Global assessment of national health sector emergency preparedness and response baseline survey were combined )] TJ ET
BT 26.250 425.842 Td /F1 9.8 Tf  [(with WHO�s six health system building blocks \(or levers\) to act as the initial analysis anchors, with a further grounded theory )] TJ ET
BT 26.250 413.937 Td /F1 9.8 Tf  [(qualitative analysis of the literature allowing the identification of emerging themes and insights. The priority areas identified by )] TJ ET
BT 26.250 402.033 Td /F1 9.8 Tf  [(this literature review were then compared with the topics covered by the new expert-consensus-derived Toolkit for assessing )] TJ ET
BT 26.250 390.128 Td /F1 9.8 Tf  [(health-system capacity for crisis management developed by the WHO Regional Office for Europe.)] TJ ET
BT 26.250 370.723 Td /F1 9.8 Tf  [(FINDINGS 143 publications identified from a literature search were analysed and appraised. Themes and examples from the )] TJ ET
BT 26.250 358.818 Td /F1 9.8 Tf  [(literature demonstrate how health system strengthening should contribute to disaster management. Priority areas under-)] TJ ET
BT 26.250 346.914 Td /F1 9.8 Tf  [(represented in the WHO Toolkit and identified by the qualitative analysis are discussed.)] TJ ET
BT 26.250 327.509 Td /F1 9.8 Tf  [(INTERPRETATION Collation and analysis of the disaster management literature identifies how health system strengthening can )] TJ ET
BT 26.250 315.604 Td /F1 9.8 Tf  [(promote resilience and efficient recovery in the face of disasters. These findings support and complement the WHO Toolkit. )] TJ ET
BT 26.250 303.699 Td /F1 9.8 Tf  [(Countries can use the literature evidence with the WHO Toolkit to assess their disaster management capacities and identify )] TJ ET
BT 26.250 291.795 Td /F1 9.8 Tf  [(priorities for strengthening their health system.)] TJ ET
BT 26.250 272.390 Td /F1 9.8 Tf  [(Citation: Bayntun C, Rockenschaub G, Murray V. Developing a health system approach to disaster management: A qualitative )] TJ ET
BT 26.250 260.485 Td /F1 9.8 Tf  [(analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management. )] TJ ET
BT 26.250 248.580 Td /F1 9.8 Tf  [(PLOS Currents Disasters. 2012 Aug 22. doi: 10.1371/5028b6037259a.)] TJ ET
BT 26.250 211.978 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 192.024 Td /F1 9.8 Tf  [(Are we prepared for disasters?)] TJ ET
BT 26.250 172.619 Td /F1 9.8 Tf  [(Each disaster and its context are different, yet many share similar health sector vulnerabilities and thus common disaster )] TJ ET
BT 26.250 160.714 Td /F1 9.8 Tf  [(management practices and policies can be built in to the health system to create resilience � the �all-hazards� approach. Four )] TJ ET
BT 26.250 148.809 Td /F1 9.8 Tf  [(recent major disasters exemplify the need for strengthened health systems.)] TJ ET
BT 26.250 129.405 Td /F1 9.8 Tf  [(The earthquake in Haiti, 12)] TJ ET
BT 143.308 133.293 Td /F1 8.7 Tf  [(th)] TJ ET
BT 150.537 129.405 Td /F1 9.8 Tf  [( Jan 2010, left 1.5 million homeless and killed 149,095 people of which 6300 died in a potentially )] TJ ET
BT 26.250 117.500 Td /F1 9.8 Tf  [(preventable cholera outbreak which infected a further 450,000 residents.)] TJ ET
0.267 0.267 0.267 rg
BT 338.952 119.007 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 343.771 117.500 Td /F1 9.8 Tf  [( Haiti lacked an effective health system prior to the )] TJ ET
BT 26.250 105.595 Td /F1 9.8 Tf  [(earthquake and national authorities were not equipped to manage relief or recovery priorities when the disaster occurred.)] TJ ET
0.267 0.267 0.267 rg
BT 547.573 107.102 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 93.690 Td /F1 9.8 Tf  [(Governance structures were destroyed and the required services, health workers, surveillance, resources, funding and )] TJ ET
BT 26.250 81.786 Td /F1 9.8 Tf  [(\(attempts at\) coordination were provided almost completely by international organisations, creating its own set of complications )] TJ ET
BT 26.250 69.881 Td /F1 9.8 Tf  [(and delaying investments into the health system.)] TJ ET
0.267 0.267 0.267 rg
BT 236.518 71.388 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 50.476 Td /F1 9.8 Tf  [(Floods in Pakistan, July to August 2010, affected 20 million people and destroyed health facilities. In spite of the public health )] TJ ET
BT 26.250 38.571 Td /F1 9.8 Tf  [(challenges, previous disaster management investment in southern Punjab region allowed for effective evacuations and saved )] TJ ET
Q
q
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BT 291.710 19.825 Td /F1 11.0 Tf  [(1)] TJ ET
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BT 516.129 713.864 Td /F4 8.7 Tf  [(5)] TJ ET
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BT 520.948 712.357 Td /F1 9.8 Tf  [( These )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(reflect the different components of a health system.)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(The earthquake and tsunami in Japan, 11)] TJ ET
BT 206.186 684.936 Td /F1 8.7 Tf  [(th)] TJ ET
BT 213.414 681.048 Td /F1 9.8 Tf  [( March 2011, caused destruction of healthcare facilities; initial shortages of food, )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(water, fuel, aid materials and rescue teams to the affected rural population; 400,000 people were evacuated to shelters with no )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(heating in freezing temperatures. However, Japan had invested in disaster management and had created a more resilient health )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(system which continued to function in spite of the challenges.)] TJ ET
0.267 0.267 0.267 rg
BT 290.173 646.841 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 625.929 Td /F1 9.8 Tf  [(WHO describes public health threats as: �new or newly emerging diseases, the accidental release or deliberate use of )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(biological, chemical or radio-nuclear agents, natural disasters, human-made disasters, complex emergencies, conflicts and )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(other events with a potentially catastrophic impact on human health�.)] TJ ET
0.267 0.267 0.267 rg
BT 321.597 603.626 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 326.416 602.119 Td /F1 9.8 Tf  [( Public health emergency preparedness has been )] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(described as �the capability of the public health and health-care systems, communities, and individuals to prevent, protect )] TJ ET
BT 26.250 578.310 Td /F1 9.8 Tf  [(against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability )] TJ ET
BT 26.250 566.405 Td /F1 9.8 Tf  [(threatens to overwhelm routine capabilities�.)] TJ ET
0.267 0.267 0.267 rg
BT 216.989 567.912 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 221.808 566.405 Td /F1 9.8 Tf  [( The inclusion of disaster �prevention� reflects the public health perspective which )] TJ ET
BT 26.250 554.500 Td /F1 9.8 Tf  [(is proposed here, whereas preparedness in �emergency management� is limited to the actions to anticipate and build response )] TJ ET
BT 26.250 542.595 Td /F1 9.8 Tf  [(capacity.)] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(Health system can be defined as �comprising all the resources, organizations and institutions that are devoted to producing )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(interdependent actions aimed principally at improving, maintaining or restoring health�.)] TJ ET
0.267 0.267 0.267 rg
BT 397.442 512.793 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 402.261 511.286 Td /F1 9.8 Tf  [( WHO describes it as being composed )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(of six building blocks, each involving public health � 1\) service delivery, 2\) health workers, 3\) health information, 4\) medical )] TJ ET
BT 26.250 487.476 Td /F1 9.8 Tf  [(products, technology and vaccines, 5\) health finance, and 6\) governance and leadership. This paper describes these )] TJ ET
BT 26.250 475.572 Td /F1 9.8 Tf  [(components as �levers� to encapsulate the complex and dynamic nature of health system�s functioning reflecting the inter-)] TJ ET
BT 26.250 463.667 Td /F1 9.8 Tf  [(dependent movements of its levers.)] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(Historically, different aspects of disaster management have been considered and discussed in isolation. However, the �multi-)] TJ ET
BT 26.250 432.357 Td /F1 9.8 Tf  [(disciplinary health systems� approach to disaster management suggests that each component of a health system needs )] TJ ET
BT 26.250 420.453 Td /F1 9.8 Tf  [(resilience to threats built in to its structure. In this way, the whole health system can be strengthened to meet the demands of )] TJ ET
BT 26.250 408.548 Td /F1 9.8 Tf  [(any type of disaster, enabling a coordinated, rapid and effective response and recovery.)] TJ ET
BT 26.250 389.143 Td /F1 9.8 Tf  [(The WHO Regional Office for Europe has adopted health system strengthening as the approach to support emergency )] TJ ET
BT 26.250 377.238 Td /F1 9.8 Tf  [(preparedness and enhancement of crisis management capacities of member states. In response to international requests, a )] TJ ET
BT 26.250 365.334 Td /F1 9.8 Tf  [(practical, action oriented Toolkit was developed and refined in a series of expert consultations.)] TJ ET
BT 26.250 345.929 Td /F1 9.8 Tf  [(The Toolkit for assessing health-system capacity for crisis management was piloted in 2007 and 2008 in an earlier version in )] TJ ET
BT 26.250 334.024 Td /F1 9.8 Tf  [(multidisciplinary country missions to Armenia, Azerbaijan and the Republic of Moldova,)] TJ ET
0.267 0.267 0.267 rg
BT 400.670 335.531 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 405.488 334.024 Td /F1 9.8 Tf  [( with the respective assessment reports )] TJ ET
BT 26.250 322.119 Td /F1 9.8 Tf  [(published on the WHO/Europe website. Based on the feedback and experience, the Toolkit was adapted and fine-tuned.)] TJ ET
BT 26.250 302.715 Td /F1 9.8 Tf  [(The Toolkit consists of a �User manual� and the �Assessment form� and is structured using the WHO health systems framework )] TJ ET
BT 26.250 290.810 Td /F1 9.8 Tf  [(� subcategorized into 16 key components and 51 essential attributes � to facilitate a structured and reproducible assessment of )] TJ ET
BT 26.250 278.905 Td /F1 9.8 Tf  [(the preparedness of health systems, based on defined indicators.)] TJ ET
BT 26.250 259.500 Td /F1 9.8 Tf  [(The final revised version, published in January 2012, was used to prepare a country report for Turkey,)] TJ ET
0.267 0.267 0.267 rg
BT 465.195 261.008 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 474.832 259.500 Td /F1 9.8 Tf  [( and Croatia. The )] TJ ET
BT 26.250 247.596 Td /F1 9.8 Tf  [(methodology has been applied for targeted assessments to evaluate public health preparedness for an increased influx of )] TJ ET
BT 26.250 235.691 Td /F1 9.8 Tf  [(migrants following the North Africa Crisis in assessment missions to Malta,)] TJ ET
0.267 0.267 0.267 rg
BT 347.542 237.198 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 357.179 235.691 Td /F1 9.8 Tf  [( Italy \(Lampedusa\))] TJ ET
0.267 0.267 0.267 rg
BT 437.919 237.198 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 447.556 235.691 Td /F1 9.8 Tf  [( and Greece \(Evros Region\).)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 225.293 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 35.887 223.786 Td /F1 9.8 Tf  [( The scope of the application of the assessment tool has been broadened towards a self-assessment methodology for )] TJ ET
BT 26.250 211.881 Td /F1 9.8 Tf  [(countries to identify gaps in health system capacities and to measure progress towards indicators.)] TJ ET
BT 26.250 192.477 Td /F1 9.8 Tf  [(A report using the WHO Toolkit to evaluate England�s health system arrangements to deal with crises, risk prevention and )] TJ ET
BT 26.250 180.572 Td /F1 9.8 Tf  [(mitigation initiatives was submitted in January 2012. The findings demonstrate the advantages of the largely integrated nature of )] TJ ET
BT 26.250 168.667 Td /F1 9.8 Tf  [(the National Health Service \(NHS\) in England in regard to disaster management, working in conjunction with the structured )] TJ ET
BT 26.250 156.762 Td /F1 9.8 Tf  [(response system that involves multi-sector collaboration and coordination.)] TJ ET
Q
q
15.000 32.239 577.500 744.761 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(lives.)] TJ ET
0.267 0.267 0.267 rg
BT 48.460 768.983 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 748.071 Td /F1 9.8 Tf  [(The famine in the Horn of Africa in 2011 affected 10 million people across several countries. Large population displacement )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(created additional public health challenges to areas that have poorly developed health systems and lack disaster preparedness. )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(Immediate priorities included � provision of water, sanitation, and shelter; trained staff to address widespread acute malnutrition; )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(surveillance for outbreaks; vaccine programmes for preventable diseases; funding; and inter-agency coordination.)] TJ ET
0.267 0.267 0.267 rg
BT 516.129 713.864 Td /F4 8.7 Tf  [(5)] TJ ET
0.271 0.267 0.267 rg
BT 520.948 712.357 Td /F1 9.8 Tf  [( These )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(reflect the different components of a health system.)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(The earthquake and tsunami in Japan, 11)] TJ ET
BT 206.186 684.936 Td /F1 8.7 Tf  [(th)] TJ ET
BT 213.414 681.048 Td /F1 9.8 Tf  [( March 2011, caused destruction of healthcare facilities; initial shortages of food, )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(water, fuel, aid materials and rescue teams to the affected rural population; 400,000 people were evacuated to shelters with no )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(heating in freezing temperatures. However, Japan had invested in disaster management and had created a more resilient health )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(system which continued to function in spite of the challenges.)] TJ ET
0.267 0.267 0.267 rg
BT 290.173 646.841 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 625.929 Td /F1 9.8 Tf  [(WHO describes public health threats as: �new or newly emerging diseases, the accidental release or deliberate use of )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(biological, chemical or radio-nuclear agents, natural disasters, human-made disasters, complex emergencies, conflicts and )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(other events with a potentially catastrophic impact on human health�.)] TJ ET
0.267 0.267 0.267 rg
BT 321.597 603.626 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 326.416 602.119 Td /F1 9.8 Tf  [( Public health emergency preparedness has been )] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(described as �the capability of the public health and health-care systems, communities, and individuals to prevent, protect )] TJ ET
BT 26.250 578.310 Td /F1 9.8 Tf  [(against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability )] TJ ET
BT 26.250 566.405 Td /F1 9.8 Tf  [(threatens to overwhelm routine capabilities�.)] TJ ET
0.267 0.267 0.267 rg
BT 216.989 567.912 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 221.808 566.405 Td /F1 9.8 Tf  [( The inclusion of disaster �prevention� reflects the public health perspective which )] TJ ET
BT 26.250 554.500 Td /F1 9.8 Tf  [(is proposed here, whereas preparedness in �emergency management� is limited to the actions to anticipate and build response )] TJ ET
BT 26.250 542.595 Td /F1 9.8 Tf  [(capacity.)] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(Health system can be defined as �comprising all the resources, organizations and institutions that are devoted to producing )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(interdependent actions aimed principally at improving, maintaining or restoring health�.)] TJ ET
0.267 0.267 0.267 rg
BT 397.442 512.793 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 402.261 511.286 Td /F1 9.8 Tf  [( WHO describes it as being composed )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(of six building blocks, each involving public health � 1\) service delivery, 2\) health workers, 3\) health information, 4\) medical )] TJ ET
BT 26.250 487.476 Td /F1 9.8 Tf  [(products, technology and vaccines, 5\) health finance, and 6\) governance and leadership. This paper describes these )] TJ ET
BT 26.250 475.572 Td /F1 9.8 Tf  [(components as �levers� to encapsulate the complex and dynamic nature of health system�s functioning reflecting the inter-)] TJ ET
BT 26.250 463.667 Td /F1 9.8 Tf  [(dependent movements of its levers.)] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(Historically, different aspects of disaster management have been considered and discussed in isolation. However, the �multi-)] TJ ET
BT 26.250 432.357 Td /F1 9.8 Tf  [(disciplinary health systems� approach to disaster management suggests that each component of a health system needs )] TJ ET
BT 26.250 420.453 Td /F1 9.8 Tf  [(resilience to threats built in to its structure. In this way, the whole health system can be strengthened to meet the demands of )] TJ ET
BT 26.250 408.548 Td /F1 9.8 Tf  [(any type of disaster, enabling a coordinated, rapid and effective response and recovery.)] TJ ET
BT 26.250 389.143 Td /F1 9.8 Tf  [(The WHO Regional Office for Europe has adopted health system strengthening as the approach to support emergency )] TJ ET
BT 26.250 377.238 Td /F1 9.8 Tf  [(preparedness and enhancement of crisis management capacities of member states. In response to international requests, a )] TJ ET
BT 26.250 365.334 Td /F1 9.8 Tf  [(practical, action oriented Toolkit was developed and refined in a series of expert consultations.)] TJ ET
BT 26.250 345.929 Td /F1 9.8 Tf  [(The Toolkit for assessing health-system capacity for crisis management was piloted in 2007 and 2008 in an earlier version in )] TJ ET
BT 26.250 334.024 Td /F1 9.8 Tf  [(multidisciplinary country missions to Armenia, Azerbaijan and the Republic of Moldova,)] TJ ET
0.267 0.267 0.267 rg
BT 400.670 335.531 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 405.488 334.024 Td /F1 9.8 Tf  [( with the respective assessment reports )] TJ ET
BT 26.250 322.119 Td /F1 9.8 Tf  [(published on the WHO/Europe website. Based on the feedback and experience, the Toolkit was adapted and fine-tuned.)] TJ ET
BT 26.250 302.715 Td /F1 9.8 Tf  [(The Toolkit consists of a �User manual� and the �Assessment form� and is structured using the WHO health systems framework )] TJ ET
BT 26.250 290.810 Td /F1 9.8 Tf  [(� subcategorized into 16 key components and 51 essential attributes � to facilitate a structured and reproducible assessment of )] TJ ET
BT 26.250 278.905 Td /F1 9.8 Tf  [(the preparedness of health systems, based on defined indicators.)] TJ ET
BT 26.250 259.500 Td /F1 9.8 Tf  [(The final revised version, published in January 2012, was used to prepare a country report for Turkey,)] TJ ET
0.267 0.267 0.267 rg
BT 465.195 261.008 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 474.832 259.500 Td /F1 9.8 Tf  [( and Croatia. The )] TJ ET
BT 26.250 247.596 Td /F1 9.8 Tf  [(methodology has been applied for targeted assessments to evaluate public health preparedness for an increased influx of )] TJ ET
BT 26.250 235.691 Td /F1 9.8 Tf  [(migrants following the North Africa Crisis in assessment missions to Malta,)] TJ ET
0.267 0.267 0.267 rg
BT 347.542 237.198 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 357.179 235.691 Td /F1 9.8 Tf  [( Italy \(Lampedusa\))] TJ ET
0.267 0.267 0.267 rg
BT 437.919 237.198 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 447.556 235.691 Td /F1 9.8 Tf  [( and Greece \(Evros Region\).)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 225.293 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 35.887 223.786 Td /F1 9.8 Tf  [( The scope of the application of the assessment tool has been broadened towards a self-assessment methodology for )] TJ ET
BT 26.250 211.881 Td /F1 9.8 Tf  [(countries to identify gaps in health system capacities and to measure progress towards indicators.)] TJ ET
BT 26.250 192.477 Td /F1 9.8 Tf  [(A report using the WHO Toolkit to evaluate England�s health system arrangements to deal with crises, risk prevention and )] TJ ET
BT 26.250 180.572 Td /F1 9.8 Tf  [(mitigation initiatives was submitted in January 2012. The findings demonstrate the advantages of the largely integrated nature of )] TJ ET
BT 26.250 168.667 Td /F1 9.8 Tf  [(the National Health Service \(NHS\) in England in regard to disaster management, working in conjunction with the structured )] TJ ET
BT 26.250 156.762 Td /F1 9.8 Tf  [(response system that involves multi-sector collaboration and coordination.)] TJ ET
Q
q
15.000 32.239 577.500 744.761 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(lives.)] TJ ET
0.267 0.267 0.267 rg
BT 48.460 768.983 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 748.071 Td /F1 9.8 Tf  [(The famine in the Horn of Africa in 2011 affected 10 million people across several countries. Large population displacement )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(created additional public health challenges to areas that have poorly developed health systems and lack disaster preparedness. )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(Immediate priorities included � provision of water, sanitation, and shelter; trained staff to address widespread acute malnutrition; )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(surveillance for outbreaks; vaccine programmes for preventable diseases; funding; and inter-agency coordination.)] TJ ET
0.267 0.267 0.267 rg
BT 516.129 713.864 Td /F4 8.7 Tf  [(5)] TJ ET
0.271 0.267 0.267 rg
BT 520.948 712.357 Td /F1 9.8 Tf  [( These )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(reflect the different components of a health system.)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(The earthquake and tsunami in Japan, 11)] TJ ET
BT 206.186 684.936 Td /F1 8.7 Tf  [(th)] TJ ET
BT 213.414 681.048 Td /F1 9.8 Tf  [( March 2011, caused destruction of healthcare facilities; initial shortages of food, )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(water, fuel, aid materials and rescue teams to the affected rural population; 400,000 people were evacuated to shelters with no )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(heating in freezing temperatures. However, Japan had invested in disaster management and had created a more resilient health )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(system which continued to function in spite of the challenges.)] TJ ET
0.267 0.267 0.267 rg
BT 290.173 646.841 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 625.929 Td /F1 9.8 Tf  [(WHO describes public health threats as: �new or newly emerging diseases, the accidental release or deliberate use of )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(biological, chemical or radio-nuclear agents, natural disasters, human-made disasters, complex emergencies, conflicts and )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(other events with a potentially catastrophic impact on human health�.)] TJ ET
0.267 0.267 0.267 rg
BT 321.597 603.626 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 326.416 602.119 Td /F1 9.8 Tf  [( Public health emergency preparedness has been )] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(described as �the capability of the public health and health-care systems, communities, and individuals to prevent, protect )] TJ ET
BT 26.250 578.310 Td /F1 9.8 Tf  [(against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability )] TJ ET
BT 26.250 566.405 Td /F1 9.8 Tf  [(threatens to overwhelm routine capabilities�.)] TJ ET
0.267 0.267 0.267 rg
BT 216.989 567.912 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 221.808 566.405 Td /F1 9.8 Tf  [( The inclusion of disaster �prevention� reflects the public health perspective which )] TJ ET
BT 26.250 554.500 Td /F1 9.8 Tf  [(is proposed here, whereas preparedness in �emergency management� is limited to the actions to anticipate and build response )] TJ ET
BT 26.250 542.595 Td /F1 9.8 Tf  [(capacity.)] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(Health system can be defined as �comprising all the resources, organizations and institutions that are devoted to producing )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(interdependent actions aimed principally at improving, maintaining or restoring health�.)] TJ ET
0.267 0.267 0.267 rg
BT 397.442 512.793 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 402.261 511.286 Td /F1 9.8 Tf  [( WHO describes it as being composed )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(of six building blocks, each involving public health � 1\) service delivery, 2\) health workers, 3\) health information, 4\) medical )] TJ ET
BT 26.250 487.476 Td /F1 9.8 Tf  [(products, technology and vaccines, 5\) health finance, and 6\) governance and leadership. This paper describes these )] TJ ET
BT 26.250 475.572 Td /F1 9.8 Tf  [(components as �levers� to encapsulate the complex and dynamic nature of health system�s functioning reflecting the inter-)] TJ ET
BT 26.250 463.667 Td /F1 9.8 Tf  [(dependent movements of its levers.)] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(Historically, different aspects of disaster management have been considered and discussed in isolation. However, the �multi-)] TJ ET
BT 26.250 432.357 Td /F1 9.8 Tf  [(disciplinary health systems� approach to disaster management suggests that each component of a health system needs )] TJ ET
BT 26.250 420.453 Td /F1 9.8 Tf  [(resilience to threats built in to its structure. In this way, the whole health system can be strengthened to meet the demands of )] TJ ET
BT 26.250 408.548 Td /F1 9.8 Tf  [(any type of disaster, enabling a coordinated, rapid and effective response and recovery.)] TJ ET
BT 26.250 389.143 Td /F1 9.8 Tf  [(The WHO Regional Office for Europe has adopted health system strengthening as the approach to support emergency )] TJ ET
BT 26.250 377.238 Td /F1 9.8 Tf  [(preparedness and enhancement of crisis management capacities of member states. In response to international requests, a )] TJ ET
BT 26.250 365.334 Td /F1 9.8 Tf  [(practical, action oriented Toolkit was developed and refined in a series of expert consultations.)] TJ ET
BT 26.250 345.929 Td /F1 9.8 Tf  [(The Toolkit for assessing health-system capacity for crisis management was piloted in 2007 and 2008 in an earlier version in )] TJ ET
BT 26.250 334.024 Td /F1 9.8 Tf  [(multidisciplinary country missions to Armenia, Azerbaijan and the Republic of Moldova,)] TJ ET
0.267 0.267 0.267 rg
BT 400.670 335.531 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 405.488 334.024 Td /F1 9.8 Tf  [( with the respective assessment reports )] TJ ET
BT 26.250 322.119 Td /F1 9.8 Tf  [(published on the WHO/Europe website. Based on the feedback and experience, the Toolkit was adapted and fine-tuned.)] TJ ET
BT 26.250 302.715 Td /F1 9.8 Tf  [(The Toolkit consists of a �User manual� and the �Assessment form� and is structured using the WHO health systems framework )] TJ ET
BT 26.250 290.810 Td /F1 9.8 Tf  [(� subcategorized into 16 key components and 51 essential attributes � to facilitate a structured and reproducible assessment of )] TJ ET
BT 26.250 278.905 Td /F1 9.8 Tf  [(the preparedness of health systems, based on defined indicators.)] TJ ET
BT 26.250 259.500 Td /F1 9.8 Tf  [(The final revised version, published in January 2012, was used to prepare a country report for Turkey,)] TJ ET
0.267 0.267 0.267 rg
BT 465.195 261.008 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 474.832 259.500 Td /F1 9.8 Tf  [( and Croatia. The )] TJ ET
BT 26.250 247.596 Td /F1 9.8 Tf  [(methodology has been applied for targeted assessments to evaluate public health preparedness for an increased influx of )] TJ ET
BT 26.250 235.691 Td /F1 9.8 Tf  [(migrants following the North Africa Crisis in assessment missions to Malta,)] TJ ET
0.267 0.267 0.267 rg
BT 347.542 237.198 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 357.179 235.691 Td /F1 9.8 Tf  [( Italy \(Lampedusa\))] TJ ET
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26.625 343.237 0.750 78.377 re f
580.125 343.237 0.750 78.377 re f
0.271 0.267 0.267 rg
BT 31.875 403.509 Td /F4 9.8 Tf  [(3\) Medical products, vaccines and technology)] TJ ET
BT 31.875 386.017 Td /F1 9.8 Tf  [(� Stockpiling disaster-related medications and equipment, and their distribution \(EA 17b, d & e, & EA 18 b, d & e\) )] TJ ET
0.267 0.267 0.267 rg
BT 519.775 386.466 Td /F4 8.7 Tf  [(29)] TJ ET
BT 529.412 386.466 Td /F4 8.7 Tf  [(36)] TJ ET
BT 539.049 386.466 Td /F4 8.7 Tf  [(37)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 367.935 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 367.935 Td /F1 9.8 Tf  [(Required characteristics for mass vaccination and understanding previous controversies)] TJ ET
BT 417.848 367.935 Td /F1 9.8 Tf  [( \(EA 18a\) )] TJ ET
0.267 0.267 0.267 rg
BT 461.743 368.384 Td /F4 8.7 Tf  [(38)] TJ ET
BT 471.380 368.384 Td /F4 8.7 Tf  [(39)] TJ ET
BT 481.017 368.384 Td /F4 8.7 Tf  [(40)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 349.853 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 349.853 Td /F1 9.8 Tf  [(Public health consequences of technology failures)] TJ ET
BT 254.233 349.853 Td /F1 9.8 Tf  [( and impact on healthcare facilities \(EA 39b & c, & EA 51\) )] TJ ET
0.267 0.267 0.267 rg
BT 505.686 350.302 Td /F4 8.7 Tf  [(41)] TJ ET
BT 515.323 350.302 Td /F4 8.7 Tf  [(42)] TJ ET
BT 524.961 350.302 Td /F4 8.7 Tf  [(43)] TJ ET
26.625 343.237 554.250 0.750 re f
26.625 250.347 0.750 93.640 re f
580.125 250.347 0.750 93.640 re f
0.271 0.267 0.267 rg
BT 31.875 325.882 Td /F4 9.8 Tf  [(4\) Health information)] TJ ET
BT 31.875 310.751 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 310.751 Td /F1 9.8 Tf  [(Requirement to optimize the performance of health information)] TJ ET
BT 308.404 310.751 Td /F1 9.8 Tf  [( at all stages of disaster planning \(EA 21a & c, & EA 23a & )] TJ ET
BT 31.875 300.759 Td /F1 9.8 Tf  [(b\), management \(EA 22b & 24\) and )] TJ ET
BT 188.499 300.759 Td /F1 9.8 Tf  [(recovery)] TJ ET
BT 225.880 300.759 Td /F1 9.8 Tf  [( \(EA 24\) )] TJ ET
0.267 0.267 0.267 rg
BT 264.354 301.208 Td /F4 8.7 Tf  [(44)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 282.677 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 282.677 Td /F1 9.8 Tf  [(Awareness of research and developments in health information tools)] TJ ET
0.267 0.267 0.267 rg
BT 333.881 283.126 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 266.955 Td /F1 9.8 Tf  [(� Communications �)] TJ ET
BT 118.728 266.955 Td /F1 9.8 Tf  [( inter-agency; two-way with the public)] TJ ET
BT 280.744 266.955 Td /F1 9.8 Tf  [(; and the )] TJ ET
BT 321.401 266.955 Td /F1 9.8 Tf  [(role of the media)] TJ ET
BT 394.019 266.955 Td /F1 9.8 Tf  [( as part of disaster management strategy )] TJ ET
BT 31.875 256.964 Td /F1 9.8 Tf  [(\(EA 28b,c & d\) )] TJ ET
0.267 0.267 0.267 rg
BT 97.990 257.413 Td /F4 8.7 Tf  [(46)] TJ ET
BT 107.627 257.413 Td /F4 8.7 Tf  [(28)] TJ ET
BT 117.264 257.413 Td /F4 8.7 Tf  [(47)] TJ ET
BT 126.902 257.413 Td /F4 8.7 Tf  [(23)] TJ ET
26.625 250.347 554.250 0.750 re f
26.625 190.802 0.750 60.295 re f
580.125 190.802 0.750 60.295 re f
0.271 0.267 0.267 rg
BT 31.875 232.992 Td /F4 9.8 Tf  [(5\) Health financing)] TJ ET
BT 31.875 215.500 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 215.500 Td /F1 9.8 Tf  [(Health finance system consequences on disaster management effectiveness and coordination)] TJ ET
BT 443.900 215.500 Td /F1 9.8 Tf  [( \(EA 31\) )] TJ ET
0.267 0.267 0.267 rg
BT 482.374 215.949 Td /F4 8.7 Tf  [(48)] TJ ET
BT 492.011 215.949 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 197.418 Td /F1 9.8 Tf  [(� Disaster management funding issues; implications for national public � and global � health \(EA 30 & 31\) )] TJ ET
0.267 0.267 0.267 rg
BT 488.331 197.867 Td /F4 8.7 Tf  [(38)] TJ ET
BT 497.968 197.867 Td /F4 8.7 Tf  [(49)] TJ ET
26.625 190.802 554.250 0.750 re f
26.625 77.011 554.250 0.750 re f
26.625 77.011 0.750 114.541 re f
580.125 77.011 0.750 114.541 re f
0.271 0.267 0.267 rg
BT 31.875 173.447 Td /F4 9.8 Tf  [(6\) Service delivery)] TJ ET
BT 31.875 155.955 Td /F1 9.8 Tf  [(� Disaster preparedness \(EA 32\), acute response \(EA 34\) and continuing service requirements \(EA 39 & EA 51\) )] TJ ET
0.267 0.267 0.267 rg
BT 515.953 156.404 Td /F4 8.7 Tf  [(50)] TJ ET
BT 525.590 156.404 Td /F4 8.7 Tf  [(40)] TJ ET
BT 535.227 156.404 Td /F4 8.7 Tf  [(51)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 137.873 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 137.873 Td /F1 9.8 Tf  [(Community preparedness strategies to increase community resilience)] TJ ET
0.267 0.267 0.267 rg
BT 338.717 138.322 Td /F4 8.7 Tf  [(52)] TJ ET
BT 348.355 138.322 Td /F4 8.7 Tf  [(53)] TJ ET
BT 357.992 138.322 Td /F4 8.7 Tf  [(54)] TJ ET
BT 367.629 138.322 Td /F4 8.7 Tf  [(55)] TJ ET
BT 377.267 138.322 Td /F4 8.7 Tf  [(56)] TJ ET
BT 386.904 138.322 Td /F4 8.7 Tf  [(57)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 119.791 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 119.791 Td /F1 9.8 Tf  [(Surge capacity development)] TJ ET
BT 161.014 119.791 Td /F1 9.8 Tf  [( within \(EA 33\) and )] TJ ET
BT 246.092 119.791 Td /F1 9.8 Tf  [(beyond healthcare facilities)] TJ ET
0.267 0.267 0.267 rg
BT 363.687 120.240 Td /F4 8.7 Tf  [(29)] TJ ET
BT 373.324 120.240 Td /F4 8.7 Tf  [(58)] TJ ET
BT 382.962 120.240 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 101.709 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 101.709 Td /F1 9.8 Tf  [(Issues in adjusting to crisis standards of care and maintaining priorities)] TJ ET
BT 343.075 101.709 Td /F1 9.8 Tf  [( \(EA 32 & EA 36a & EA 38i\) )] TJ ET
0.267 0.267 0.267 rg
BT 466.101 102.158 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 83.627 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 83.627 Td /F1 9.8 Tf  [(Safeguarding patient�s medical records)] TJ ET
BT 206.527 83.627 Td /F1 9.8 Tf  [( and medication needs \(EA 44a\) )] TJ ET
BT 348.516 83.627 Td /F1 9.8 Tf  [(during disaster)] TJ ET
0.267 0.267 0.267 rg
BT 412.456 84.076 Td /F4 8.7 Tf  [(48)] TJ ET
BT 422.094 84.076 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(Discussion of the literature evidence.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The WHO Toolkit provides a generic resource, enabling countries to increase the resilience of their health system to manage risks of disasters using an all-hazards approach. The qualitative analysis of the collated worldwide experience of disasters since 2000 provides a complementary literature-based approach to support and enhance the expert-consensus process used in the development of the Toolkit. The analysis has identified many priorities well represented in the Toolkit and a few areas that are under-represented.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Areas that are well represented in both the literature and the toolkit pertain to legal and governance structures for emergency management. These include prioritising national multisectoral coordination as well as health-sector emergency management. The importance of partnership-building is also recognised. Human resource development is another key component that is found in the Toolkit and widely discussed in the literature. This includes disaster training and education for health workers. Logistics and operational support for acute response delivery and the continuation of essential services during disasters are areas well represented in the Toolkit.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(A selection of under-represented areas is discussed below.)] TJ ET
BT 0.000 782.981 Td /F4 9.8 Tf  [(1\) Leadership and governance. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Interwoven nature of the legal system, ethical decision-making and disaster management.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The importance of explicitly including ethical decision-making processes in disaster management is not widespread in practice, nor mentioned in the Toolkit. For example, Thomas� survey of disaster planners in the United States of America found that both ethical training and expertise were lacking, and concludes that there is a �risk of making many unjust and regrettable decisions� The allocation of resources and the application of control measures have enormous ethical implications, not only in the saving of lives but also in the preservation of human rights, maintenance of a functioning society, and the achievement of social justice�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(25)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( The balance between individual rights versus public health benefits can be particularly difficult in times of crisis, such as the need to isolate or quarantine individuals to protect a wider population. It is important to prepare guidelines in advance so that they can be drawn upon at the time of a disaster without further delay or due consultation; transparency in decision-making is important.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Disaster management as a political issue.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Several authors concentrate on the involvement of political leaders due to the inherently political nature of decision-making during disasters � �Never has public health been more political or the linkages with government stronger or more demanding�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(28)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Hick argues that political authorities must be well-versed on issues, such as the allocation of scarce resources, and should be willing to trust the advice of public health and health care agencies )] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(. Political leaders determine what constitutes an �emergency�, and their laws determine issues regarding response, such as the extent of responsibility for potential or actual harms that occur as a result of the emergency.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(2\) Health workers. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Establishing the commitment and welfare of health workers.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Levin acknowledges that health workers are at risk of becoming infected early in a pandemic and emphasises the need to address their fears and concerns in advance, highlighting the survey finding that only 48% of health workers in the United States of America would currently report to work in such a scenario.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Health workers need to be confident that they will have access to all relevant protective equipment, vaccines, prophylaxis and treatments.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Barnett et al have explored this issue in relation to Public Health workers, and identify that rural cohorts are more willing to respond than urban based workers. They suggest that further investigation may identify factors that influence willingness to respond.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(60)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(3\) Health information. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Use of health information systems in disaster recovery.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Tools to support disaster recovery are important. An example is the �Dashboard Project� developed following Hurricane Katrina to produce demographic, economic and health indicators for the most severely affected areas, enabling ongoing disaster recovery.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(44)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Effective post-disaster surveillance can limit the risk of a further disasters caused by secondary causes. Infectious diseases, such as cholera or measles, can be catastrophic in vulnerable populations,)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(61)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( and mental health problems are common in the wake of disasters.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(47)] TJ ET
BT 0.000 783.983 Td /F4 8.7 Tf  [(62)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Geographic Information Systems can be used to support the identification of populations that will require resources and new services post-disaster, enhancing information provided by other surveillance systems.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Awareness of developments in health information tools.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( There is a need to improve health information systems so that they provide �rich patient data�, such as by increasing the range of data sources and undertaking real-time public health surveillance for emergency planning and response. Chretien suggests that tools should seek to enhance human judgment rather than replace it, allowing specific circumstances to be suitably analysed. There have been many developments in disaster management since 2000, but evaluations of information systems are lacking.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Communications � inter-agency; two-way with the public; and the role of the media as part of disaster management strategy.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The importance of crisis and risk communication is widely recognised in the literature. There are many levels at which communications must be rigorous during a crisis. For example, Dorn�s survey measures �connectivity� between disaster management agencies to evaluate public health preparedness and response.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Harris analysis �social networks� of public health disaster planners to reveal a paucity of networking with high-level and private-sector contacts, which the authors feel are necessary for managing an effective response to a disaster.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(46)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Klitzman recommends �early two-way communication \(with the public\)� to reduce distrust and maintain credibility�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Thus the media should be an integral part of the disaster strategy, with experts providing information.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( This ensures that messages are consistent, responsive, and can mitigate unnecessary anxiety.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(65)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(4\) Vaccinations. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Mass vaccination issues.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The literature describes significant controversy over examples of mass vaccination proposals.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(38)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Hupert models the likely demand on emergency health facilities as a direct result of adverse events following a mass vaccination program, finding that short vaccination campaigns would overwhelm capacity.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(39)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Noji considers that mass vaccination is rarely advisable, ineffectually diverting limited resources.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(40)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(However, each scenario must be independently judged as in certain circumstances failing to mass vaccinate against an infectious disease, such as measles, can have catastrophic consequences.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(66)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Public health consequences of technology failures and impact on healthcare facilities.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Prezant, using data showing that even back-up systems can be overwhelmed, suggests that public health disaster planning needs to include a wide spectrum of activities and training.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(43)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bluth describes the impact of power failure on medical technologies in a hospital department, rendering services crucial to the disaster response inadequate.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Public health consequences of a power failure, which may form only a part of a disaster, require contingency planning.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(42)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(5\) Finance systems. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Health finance system consequences on disaster management effectiveness and coordination. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(In times of crisis, issues relating to health finance and payment systems become acute.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(48)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Disaster preparedness requires clear policies that are effective regardless of the specific funding arrangements. However, conclusions from the literature emphasise that universal access to health care without out-of-pocket payment, facilitates earlier detection of new diseases, better enables disease-control and surveillance, and minimises detriment to population health caused by delayed care.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Further, in research conducted on pandemic influenza preparedness in Europe, Mournier-Jack concluded that health insurance providers should support plans to reach vaccine coverage thresholds and provide antiviral medications when required.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(6\) Service delivery. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Community preparedness strategies to increase community resilience. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Communities need to have a comprehensive planning process, a thorough emergency operations plan, established response capability, and an ongoing surveillance and notification system for communicating emergencies.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(53)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Matteson proposes the preparation of �home disaster kits� and information on �how to prepare a shelter at home during a pandemic�. The dissemination of these public health messages, they argue, �has the additional benefit of making the larger community aware of public health preparedness activities�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(57)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( These approaches are particularly important amongst communities that may lack resilience. Bouye concentrates on this issue, describing vulnerability as being as a result of �social and personal factors� confounded by system, policy and institutional factors�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(67)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( A community can become empowered and act as a �resource� rather than a �victim� following training in search and rescue, care and shelter, emergency communications, and so on.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(52)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Surge capacity development beyond healthcare facilities. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hick suggests expanding ambulatory care surge capacity to reduce pressure on hospitals, allowing them to concentrate on persons requiring higher levels of medical attention. The authors list a set of potential alternative care sites and factors to consider in the selection, while advocating the need to facilitate home family-based care.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( In support of home-care provision, Levin considers -�Placing large numbers of infected people in one congested \(alternative care site\) setting, which will probably have inadequate facilities for personal hygiene and sanitation, could serve to promote its spread and provide marginal care at best�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Issues in adjusting to crisis standards of care and maintaining priorities. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(The health system may become overwhelmed during a disaster requiring adjustments in standards of care and the triaged allocation of limited resources. Gostin defines crisis standards of care as �the optimal level of health care that can be delivered during a catastrophic event, requiring a substantial change in usual health care operations.� Protocols, previously prepared by experts via an evidence-based, peer-reviewed process, should be provided for use in a disaster to guide clinicians with decision-making.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Hick proposes a tiered system of resources and coordination mechanisms, in which an inadequacy of resources at one level \(such as community\) activates the next tier of response \(such as regional\), and so on.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( There should be an established system allowing for an immediate request for assistance from neighbouring regions, and arrangements for the transfer of patients. Legal mandates may be helpful in this regard, particularly with mutual aid agreements to transfer special care patients from a nursing home, hospice or with other chronic disease such as requiring kidney dialysis.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Safeguarding patient�s medical records and medication needs during disaster.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Several authors focus on the need to create central databases of patient�s medical histories and medications.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(48)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Arrieta highlights that patients generally lack knowledge about their medical history and thus advises that patients should be provided with summaries that can be distributed, with prescriptions linked to pharmacies with central databases.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(Implications for public health, policy and disaster management multi-professionals.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Using evidence and practical experience drawn from the published literature to complement the WHO Toolkit, planners from around the world can evaluate the status of their current health system in regard to disaster management. This information can help to identify the most effective developments to be made across all levers to enhance their preparedness and resilience to all-hazards disasters.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(This initial exploration provides scope for development. Future research should consider the usability and effectiveness of the health system strengthening approach across a range of low, middle and high income countries, each with their unique health system structures, environment and resource implications. The search of the core literature results in a bias towards the highly resourced United States of America, whilst the grey literature provides insights into disaster management in low-income countries. A variety of documents were included in the review, such as opinion pieces and case reports. These expose important areas of controversy and present useful, all be it specific, experiences in the field. The nature of disasters means that each incident can identify important lessons, and thus have been included in this collation.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(The changing climate is increasing threats, leading to �changes in the frequency, intensity, spatial extent, duration, and timing of extreme weather and climate events, and can result in unprecedented extreme weather and climate events�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(68)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( The impact is significant in large parts of the developing world where populations and health systems are already vulnerable, and disaster response management and infrastructure lacking. This work may be progressed to reduce health system vulnerabilities for these populations.)] TJ ET
BT 0.000 780.900 Td /F4 12.0 Tf  [(Conclusion)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Ministries and Departments of Health within countries should consider prioritising preparedness for their most likely threats, and yet plan for an all-hazards approach to disasters. Their governments have the ultimate responsibility to be able to train staff, manage a surge in need, conduct timely surveillance, prevent secondary consequences and minimise morbidity and mortality. Health agencies at the highest level need to be able to coordinate with other agencies, collaborate with other countries, communicate effectively amongst themselves and with the public, engage communities, build resilience and deliver an efficient recovery. This requires being abreast of developments in disaster management, accessing the most useful tools, with continuous planning and reflective research to identify lessons from past disasters. Previously there has been no database or collated resource of disaster management lessons, meaning that essential experience is being forgotten.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(In summary, the qualitative analysis of the disaster management experience found in the published literature supports the value and content of the WHO Toolkit by identifying lessons from the actual worldwide experience of disasters since 2000. In combination, this work sets out a health system strengthening approach to building disaster management capacity. It has international relevance and applicability, as highlighted by the recent World Health Assembly�s agenda item and WHO�s commitment to developing the health system approach to disaster management. This approach will contribute to sustainable health system resilience for populations in the face of disasters.)] TJ ET
BT 0.000 780.900 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(					Claire Bayntun is grateful to be funded by NIHR as an Academic Clinical Fellow in Public Health.The Department of Primary Care & Public Health at Imperial College London is grateful for support from the NIHR Collaboration for Leadership in Applied Health Research & Care \(CLAHRC\) Scheme, the NIHR Biomedical Research Centre scheme, and the Imperial Centre for Patient Safety and Service Quality. There are no conflicts of interest.				)] TJ ET
BT 0.000 780.900 Td /F4 12.0 Tf  [(References)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO. PAHO's Interactive Report of Cholera Outbreak. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(PAHO. Health response to the earthquake in Haiti 2010; Lessons to be learned for the next massive sudden-onset disaster. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Responding in a Crisis: The Role of National and International Health Workers � Lessons from Haiti: Merlin; 2010. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Pakistan Floods Progress Report July 2010 / July 2011: Oxfam; 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Public health risk assessment and interventions - The Horn of Africa: Drought and famine crisis ; 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Matsumoto M, Inoue K. Earthquake, tsunami, radiation leak, and crisis in rural health in Japan. Rural and Remote Health 2011;1759\(11\).)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Strengthening health-system emergency preparedness: Toolkit for Assessing Health System Capacity for Crisis Management. 2012)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 785.062 Td /F1 7.5 Tf  [(Reference Link)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Nelson, Lurie, Wasserman, Zakowski. Conceptualising and defining public health preparedness. Am J of PH 2007;97\(Suppl 1\):S9-11. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Assessment of health security and crises management. Armenia, Azerbaijan, Republic of Moldova. 2007-8. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Assessment of health systems crisis preparedness, Turkey. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Health Needs Assessment, Malta 2011. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Press Release: Conclusions of the health mission in Lampedusa. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Greece Mission Report 2011. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bayntun C. How can health system strengthening contribute to disaster management? A systematic review and qualitative analysis of the literatureWHO Collaborating Centre for Public Health Training & Education, Imperial College, London. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hyogo Framework for Action 2005-2015: Building the resilience of nations and communities to disasters; 2005. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bayntun C. A health system approach to all-hazards disaster management:A systematic review. Submitted for publication - 2012. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Harden A, Garcia J, Oliver S, Rees R, Shepherd J, Brunton G, et al. Applying systematic review methods to studies of people�s views: an example from public health research. Epidemiology & Community Health 2004;58:794-800. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Global Assessment of National Health Sector Emergency Preparedness and Response ; 2008. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Glaser BG, Strauss A. Discovery of Grounded Theory: Strategies for Qualitative Research : Sociology Press; 1967. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Mounier-Jack S, Coker RJ. How prepared is Europe for pandemic influenza? Analysis of national plans. Lancet 2006 Apr 29;367\(9520\):1405-1411. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Roffey R, Lantorp K, Tegnell A, Elgh F. Biological weapons and bioterrorism preparedness: Importance of public-health awareness and international cooperation. Clinical Microbiology and Infection 2002;8\(8\) \(pp 522-528\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Jones M, O'Carroll P, Thompson J, D'Ambrosio L. Assessing regional public health preparedness: A new tool for considering cross-border issues. Journal of Public Health Management and Practice 2008;14\(5 \(pp E15-E22\)\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Kahn LH, Barondess JA. Preparing for disaster: Response matrices in the USA and UK. Journal of Urban Health 2008;85\(6\) \(pp 910-922\).)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Barnett DJ, Taylor HA, Hodge JG,Jr, Links JM. Resource allocation on the frontlines of public health preparedness and response: report of a summit on legal and ethical issues. Public Health Rep 2009 Mar-Apr;124\(2\):295-303. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Thomas JC, Dasgupta N, Martinot A. Ethics in a pandemic: a survey of the state pandemic influenza plans. Am J Public Health 2007 Apr;97 Suppl 1:S26-31. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Wynia MK, Gostin LO. Ethical challenges in preparing for bioterrorism: barriers within the health care system. Am J Public Health 2004 Jul;94\(7\):1096-1102. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Gostin LO, Hanfling D. National preparedness for a catastrophic emergency: crisis standards of care. JAMA 2009 Dec 2;302\(21\):2365-2366. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Jacobs LM, Burns KJ, Gross RI. Terrorism: a public health threat with a trauma system response. J Trauma 2003 Dec;55\(6\):1014-1021. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hick JL, Hanfling D, Burstein JL, DeAtley C, Barbisch D, Bogdan GM, et al. Health care facility and community strategies for patient care surge capacity. Ann Emerg Med 2004 Sep;44\(3\):253-261. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Olson D, Hoeppner M, Larson S, Ehrenberg A, Leitheiser AT. Lifelong learning for public health practice education: a model curriculum for bioterrorism and emergency readiness. Public Health Rep 2008;123 Suppl 2:53-64. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Markenson D, DiMaggio C, Redlener I. Preparing health professions students for terrorism, disaster, and public health emergencies: core competencies. Acad Med 2005 Jun;80\(6\):517-526. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Fowkes V, Blossom HJ, Anderson HK, Sandrock C. Emergency Preparedness for Health Professionals in a Statewide AHEC Program: the first two years. Acad Med 2007 Aug;82\(8\):781-787. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Potter MA, Miner KR, Barnett DJ, Cadigan R, Lloyd L, Olson DK, et al. The evidence base for effectiveness of preparedness training: a retrospective analysis. Public Health Rep 2010 Nov-Dec;125\(Suppl 5\):15-23. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Biddinger PD, Savoia E, Massin-Short SB, Preston J, Stoto MA. Public health emergency preparedness exercises: lessons learned. Public Health Rep 2010 Nov-Dec;125\(Suppl 5\):100-106. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Levin PJ, Gebbie EN, Qureshi K. Can the health-care system meet the challenge of pandemic flu? Planning, ethical, and workforce considerations. Public Health Rep 2007 Sep-Oct;122\(5\):573-578. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Ziskin LZ, Harris DA. State health policy for terrorism preparedness. Am J Public Health 2007 Sep;97\(9\):1583-1588. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Massoomi F. Pharmacists in the Omaha Metropolitan Medical Response System. American Journal of Health-System Pharmacy 2005;62\(12\) \(pp 1290-1298\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Cohen HW, Gould RM, Sidel VW. The pitfalls of bioterrorism preparedness: the anthrax and smallpox experiences. Am J Public Health 2004 Oct;94\(10\):1667-1671. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hupert N, Wattson D, Cuomo J, Benson S. Anticipating Demand for Emergency Health Services due to Medication-related Adverse Events after Rapid Mass Prophylaxis Campaigns. Acad Emerg Med 2007;14\(3 \(pp 268-274\)\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Noji EK. Public health issues in disasters. Crit Care Med 2005 Jan;33\(1 Suppl\):S29-33. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bluth EI, Kay D, Smetherman D, DeVun D, Eick J, Matthews C, et al. Managing in a catastrophe: radiology during Hurricane Katrina. AJR Am J Roentgenol 2007 Mar;188\(3\):630-632. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Beatty ME, Phelps S, Rohner MC, Weisfuse MI. Blackout of 2003: public health effects and emergency response. Public Health Rep 2006 Jan-Feb;121\(1\):36-44. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Prezant DJ, Clair J, Belyaev S, Alleyne D, Banauch GI, Davitt M, et al. Effects of the August 2003 blackout on the New York City healthcare delivery system: a lesson for disaster preparedness. Crit Care Med 2005 Jan;33\(1 Suppl\):S96-101. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Stone G, Lekht A, Burris N, Williams C. Data collection and communications in the public health response to a disaster: Rapid population estimate surveys and the daily Dashboard in post-Katrina New Orleans. Journal of Public Health Management and Practice 2007;13\(5\) \(pp 453-460\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Chretien JP, Tomich NE, Gaydos JC, Kelley PW. Real-time public health surveillance for emergency preparedness. Am J Public Health 2009 Aug;99\(8\):1360-1363. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Harris JK, Clements B. Using social network analysis to understand Missouri's system of public health emergency planners. Public Health Rep 2007 Jul-Aug;122\(4\):488-498. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Klitzman S, Freudenberg N. Implications of the World Trade Center attack for the public health and health care infrastructures. Am J Public Health 2003 Mar;93\(3\):400-406. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Lurie N. H1N1 influenza, public health preparedness, and health care reform. N Engl J Med 2009 Aug 27;361\(9\):843-845. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Schmitt B, Dobrez D, Parada JP, Kyriacou DN, Golub RM, Sharma R, et al. Responding to a small-scale bioterrorist anthrax attack: Cost-effectiveness analysis comparing preattack vaccination with postattack antibiotic treatment and vaccination. Arch Intern Med 2007;167\(7\) \(pp 655-662\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Broz D, Levin EC, Mucha AP, Pelzel D, Wong W, Persky VW, et al. Lessons learned from Chicago's emergency response to mass evacuations caused by Hurricane Katrina. Am J Public Health 2009 Aug;99\(8\):1496-1504. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Keeney GB. Disaster preparedness: What do we do now?. Journal of Midwifery and Women's Health 2004;49\(4 Suppl.\) \(pp 2-6\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Lichterman JD. A "community as resource" strategy for disaster response. Public Health Rep 2000 Mar-Jun;115\(2-3\):262-265. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Braun BI, Wineman NV, Finn NL, Barbera JA, Schmaltz SP, Loeb JM. Integrating hospitals into community emergency preparedness planning. Ann Intern Med 2006 06 Jun 2006;144\(11\):799-811. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Davey VJ. Disaster care: questions and answers on pandemic influenza. Striking a balance between risk and preparedness. Am J Nurs 2007 Jul;107\(7\):50-6; quiz 57. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Biddinger PD, Cadigan RO, Auerbach BS, Burstein JL, Savoia E, Stoto MA, et al. On linkages: using exercises to identify systems-level preparedness challenges. Public Health Rep 2008 Jan-Feb;123\(1\):96-101. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hien LTT, Takano T, Seino K, Ohnishi M, Nakamura K. Effectiveness of a capacity-building program for community leaders in a healthy living environment: A randomized community-based intervention in rural Vietnam. Health Promot Internation 2008;23\(4 \(pp 354-364\)\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Matteson LM. Using seasonal influenza clinics for public health preparedness exercises. Am J Nurs 2006 Oct;106\(10\):28-29. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Eastman AL, Rinnert KJ, Nemeth IR, Fowler RL, Minei JP. Alternate site surge capacity in times of public health disaster maintains trauma center and emergency department integrity: Hurricane Katrina. J Trauma 2007 Aug;63\(2\):253-257. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Arrieta MI, Foreman RD, Crook ED, Icenogle ML. Insuring continuity of care for chronic disease patients after a disaster: key preparedness elements. Am J Med Sci 2008 Aug;336\(2\):128-133. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Barnett DJ, Thompson CB, Errett NA, Semon NL, Anderson MK, Ferrell JL, Freiheit JM, Hudson R, Koch MM, McKee M, Mejia-Echeverry A, Spitzer J, Balicer RD, Links JM. Determinants of emergency response willingness in the local public health workforce by jurisdictional and scenario patterns: a cross-sectional survey. BMC Public Health 2012;Mar 7;12:164. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Goma Epidemiology Group. Public health impact of Rwandan refugee crisis: what happened in Goma, Zaire, in July, 1994? Lancet 1995 Feb 11;345\(8946\):339-344.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Schoenbaum M, Butler B, Kataoka S, Norquist G, Springgate B, Sullivan G, et al. Promoting mental health recovery after hurricanes Katrina and Rita: what can be done at what cost. Arch Gen Psychiatry 2009 Aug;66\(8\):906-914. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Doocy S, Gorokhovich Y, Burnham G, Balk D, Robinson C. Tsunami mortality estimates and vulnerability mapping in Aceh, Indonesia. Am J Public Health 2007 Apr;97 Suppl 1:S146-51. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Dorn BC, Savoia E, Testa MA, Stoto MA, Marcus LJ. Development of a survey instrument to measure connectivity to evaluate national public health preparedness and response performance. Public Health Rep 2007 May-Jun;122\(3\):329-338. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hawryluck L, Lapinsky SE, Stewart TE. Clinical review: SARS - Lessons in disaster management. Critical Care 2005;9\(4\) \(pp 384-389\):ate of Pubaton: Aug 2005. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL. Communicable diseases in complex emergencies: impact and challenges. Lancet 2004;Nov 27-Dec 3;364\(9449\):1974-83. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bouye K, Truman BI, Hutchins S, Richard R, Brown C, Guillory JA, et al. Pandemic influenza preparedness and response among public-housing residents, single-parent families, and low-income populations. Am J Public Health 2009 Oct;99 Suppl 2:S287-93. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(IPCC. Managing the Risks of Extreme Events and Disasters to AdvanceClimate Change Adaptation - A Special Report of Working Group I and Working Group II of the Intergovernmental Panel on Climate Change. 2011. )] TJ ET
Q
q
15.000 31.636 577.500 745.364 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Panel 1 Health system priorities in all-hazards disaster management � with references)] TJ ET
Q
0.965 0.965 0.965 rg
26.250 722.588 555.000 33.175 re f
0.267 0.267 0.267 rg
0.267 0.267 0.267 RG
26.250 755.764 m 581.250 755.764 l 580.500 755.014 l 27.000 755.014 l  f
581.250 755.764 m 581.250 722.588 l 580.500 722.588 l 580.500 755.014 l  f
26.250 755.764 m 26.250 722.588 l 27.000 722.588 l 27.000 755.014 l  f
0.271 0.267 0.267 rg
BT 33.000 741.688 Td /F1 9.0 Tf  [(EA � Essential attribute reference from the Toolkit for assessing health-systems capacity for crisis management in the WHO Regional )] TJ ET
BT 33.000 732.042 Td /F1 9.0 Tf  [(Office for Europe )] TJ ET
0.267 0.267 0.267 rg
BT 103.533 732.456 Td /F4 8.0 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 107.981 732.042 Td /F1 9.0 Tf  [(. Underlined priorities highlight areas that are under-represented by the Toolkit, and are discussed further below)] TJ ET
1.000 1.000 1.000 rg
26.250 76.636 555.000 645.953 re f
0.267 0.267 0.267 rg
26.625 721.463 554.250 0.750 re f
26.625 636.205 0.750 86.008 re f
580.125 636.205 0.750 86.008 re f
0.271 0.267 0.267 rg
BT 31.875 704.108 Td /F4 9.8 Tf  [(1\) Leadership and governance)] TJ ET
BT 31.875 688.977 Td /F1 9.8 Tf  [(� International, national and cross-boundary systems of governance, coordination and response for all-hazards disasters )] TJ ET
BT 31.875 678.985 Td /F1 9.8 Tf  [(\(Toolkit essential attribute 1a & 2a\).)] TJ ET
0.267 0.267 0.267 rg
BT 185.233 679.434 Td /F4 8.7 Tf  [(20)] TJ ET
BT 194.870 679.434 Td /F4 8.7 Tf  [(21)] TJ ET
BT 204.507 679.434 Td /F4 8.7 Tf  [(22)] TJ ET
BT 214.145 679.434 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 660.903 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 660.903 Td /F1 9.8 Tf  [(Interwoven nature of the legal system, ethical decision-making)] TJ ET
BT 306.776 660.903 Td /F1 9.8 Tf  [( and disaster management \(EA 3d\). )] TJ ET
0.267 0.267 0.267 rg
BT 463.390 661.352 Td /F4 8.7 Tf  [(24)] TJ ET
BT 473.028 661.352 Td /F4 8.7 Tf  [(25)] TJ ET
BT 482.665 661.352 Td /F4 8.7 Tf  [(26)] TJ ET
BT 492.303 661.352 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 642.821 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 642.821 Td /F1 9.8 Tf  [(Disaster management as a political issue)] TJ ET
BT 215.185 642.821 Td /F1 9.8 Tf  [( requiring strong leadership skills \(EA 4d and EA 6d\). )] TJ ET
0.267 0.267 0.267 rg
BT 446.572 643.270 Td /F4 8.7 Tf  [(28)] TJ ET
BT 456.209 643.270 Td /F4 8.7 Tf  [(29)] TJ ET
26.625 636.205 554.250 0.750 re f
26.625 420.864 0.750 216.091 re f
580.125 420.864 0.750 216.091 re f
0.271 0.267 0.267 rg
BT 31.875 618.850 Td /F4 9.8 Tf  [(2\) Health workforce)] TJ ET
BT 31.875 601.358 Td /F1 9.8 Tf  [(� Public health training in disaster management and evaluation )] TJ ET
0.267 0.267 0.267 rg
BT 304.085 601.807 Td /F4 8.7 Tf  [(30)] TJ ET
BT 313.723 601.807 Td /F4 8.7 Tf  [(31)] TJ ET
BT 323.360 601.807 Td /F4 8.7 Tf  [(32)] TJ ET
BT 332.997 601.807 Td /F4 8.7 Tf  [(33)] TJ ET
BT 342.635 601.807 Td /F4 8.7 Tf  [(34)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 583.276 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 583.276 Td /F1 9.8 Tf  [(Establishing the commitment, welfare)] TJ ET
BT 199.468 583.276 Td /F1 9.8 Tf  [( and volunteer-credentialing)] TJ ET
BT 319.773 583.276 Td /F1 9.8 Tf  [( of health workers)] TJ ET
BT 396.720 583.276 Td /F1 9.8 Tf  [( \(EA 15c\). )] TJ ET
0.267 0.267 0.267 rg
BT 442.779 583.725 Td /F4 8.7 Tf  [(35)] TJ ET
BT 452.416 583.725 Td /F4 8.7 Tf  [(26)] TJ ET
26.625 420.864 554.250 0.750 re f
26.625 343.237 0.750 78.377 re f
580.125 343.237 0.750 78.377 re f
0.271 0.267 0.267 rg
BT 31.875 403.509 Td /F4 9.8 Tf  [(3\) Medical products, vaccines and technology)] TJ ET
BT 31.875 386.017 Td /F1 9.8 Tf  [(� Stockpiling disaster-related medications and equipment, and their distribution \(EA 17b, d & e, & EA 18 b, d & e\) )] TJ ET
0.267 0.267 0.267 rg
BT 519.775 386.466 Td /F4 8.7 Tf  [(29)] TJ ET
BT 529.412 386.466 Td /F4 8.7 Tf  [(36)] TJ ET
BT 539.049 386.466 Td /F4 8.7 Tf  [(37)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 367.935 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 367.935 Td /F1 9.8 Tf  [(Required characteristics for mass vaccination and understanding previous controversies)] TJ ET
BT 417.848 367.935 Td /F1 9.8 Tf  [( \(EA 18a\) )] TJ ET
0.267 0.267 0.267 rg
BT 461.743 368.384 Td /F4 8.7 Tf  [(38)] TJ ET
BT 471.380 368.384 Td /F4 8.7 Tf  [(39)] TJ ET
BT 481.017 368.384 Td /F4 8.7 Tf  [(40)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 349.853 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 349.853 Td /F1 9.8 Tf  [(Public health consequences of technology failures)] TJ ET
BT 254.233 349.853 Td /F1 9.8 Tf  [( and impact on healthcare facilities \(EA 39b & c, & EA 51\) )] TJ ET
0.267 0.267 0.267 rg
BT 505.686 350.302 Td /F4 8.7 Tf  [(41)] TJ ET
BT 515.323 350.302 Td /F4 8.7 Tf  [(42)] TJ ET
BT 524.961 350.302 Td /F4 8.7 Tf  [(43)] TJ ET
26.625 343.237 554.250 0.750 re f
26.625 250.347 0.750 93.640 re f
580.125 250.347 0.750 93.640 re f
0.271 0.267 0.267 rg
BT 31.875 325.882 Td /F4 9.8 Tf  [(4\) Health information)] TJ ET
BT 31.875 310.751 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 310.751 Td /F1 9.8 Tf  [(Requirement to optimize the performance of health information)] TJ ET
BT 308.404 310.751 Td /F1 9.8 Tf  [( at all stages of disaster planning \(EA 21a & c, & EA 23a & )] TJ ET
BT 31.875 300.759 Td /F1 9.8 Tf  [(b\), management \(EA 22b & 24\) and )] TJ ET
BT 188.499 300.759 Td /F1 9.8 Tf  [(recovery)] TJ ET
BT 225.880 300.759 Td /F1 9.8 Tf  [( \(EA 24\) )] TJ ET
0.267 0.267 0.267 rg
BT 264.354 301.208 Td /F4 8.7 Tf  [(44)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 282.677 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 282.677 Td /F1 9.8 Tf  [(Awareness of research and developments in health information tools)] TJ ET
0.267 0.267 0.267 rg
BT 333.881 283.126 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 266.955 Td /F1 9.8 Tf  [(� Communications �)] TJ ET
BT 118.728 266.955 Td /F1 9.8 Tf  [( inter-agency; two-way with the public)] TJ ET
BT 280.744 266.955 Td /F1 9.8 Tf  [(; and the )] TJ ET
BT 321.401 266.955 Td /F1 9.8 Tf  [(role of the media)] TJ ET
BT 394.019 266.955 Td /F1 9.8 Tf  [( as part of disaster management strategy )] TJ ET
BT 31.875 256.964 Td /F1 9.8 Tf  [(\(EA 28b,c & d\) )] TJ ET
0.267 0.267 0.267 rg
BT 97.990 257.413 Td /F4 8.7 Tf  [(46)] TJ ET
BT 107.627 257.413 Td /F4 8.7 Tf  [(28)] TJ ET
BT 117.264 257.413 Td /F4 8.7 Tf  [(47)] TJ ET
BT 126.902 257.413 Td /F4 8.7 Tf  [(23)] TJ ET
26.625 250.347 554.250 0.750 re f
26.625 190.802 0.750 60.295 re f
580.125 190.802 0.750 60.295 re f
0.271 0.267 0.267 rg
BT 31.875 232.992 Td /F4 9.8 Tf  [(5\) Health financing)] TJ ET
BT 31.875 215.500 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 215.500 Td /F1 9.8 Tf  [(Health finance system consequences on disaster management effectiveness and coordination)] TJ ET
BT 443.900 215.500 Td /F1 9.8 Tf  [( \(EA 31\) )] TJ ET
0.267 0.267 0.267 rg
BT 482.374 215.949 Td /F4 8.7 Tf  [(48)] TJ ET
BT 492.011 215.949 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 197.418 Td /F1 9.8 Tf  [(� Disaster management funding issues; implications for national public � and global � health \(EA 30 & 31\) )] TJ ET
0.267 0.267 0.267 rg
BT 488.331 197.867 Td /F4 8.7 Tf  [(38)] TJ ET
BT 497.968 197.867 Td /F4 8.7 Tf  [(49)] TJ ET
26.625 190.802 554.250 0.750 re f
26.625 77.011 554.250 0.750 re f
26.625 77.011 0.750 114.541 re f
580.125 77.011 0.750 114.541 re f
0.271 0.267 0.267 rg
BT 31.875 173.447 Td /F4 9.8 Tf  [(6\) Service delivery)] TJ ET
BT 31.875 155.955 Td /F1 9.8 Tf  [(� Disaster preparedness \(EA 32\), acute response \(EA 34\) and continuing service requirements \(EA 39 & EA 51\) )] TJ ET
0.267 0.267 0.267 rg
BT 515.953 156.404 Td /F4 8.7 Tf  [(50)] TJ ET
BT 525.590 156.404 Td /F4 8.7 Tf  [(40)] TJ ET
BT 535.227 156.404 Td /F4 8.7 Tf  [(51)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 137.873 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 137.873 Td /F1 9.8 Tf  [(Community preparedness strategies to increase community resilience)] TJ ET
0.267 0.267 0.267 rg
BT 338.717 138.322 Td /F4 8.7 Tf  [(52)] TJ ET
BT 348.355 138.322 Td /F4 8.7 Tf  [(53)] TJ ET
BT 357.992 138.322 Td /F4 8.7 Tf  [(54)] TJ ET
BT 367.629 138.322 Td /F4 8.7 Tf  [(55)] TJ ET
BT 377.267 138.322 Td /F4 8.7 Tf  [(56)] TJ ET
BT 386.904 138.322 Td /F4 8.7 Tf  [(57)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 119.791 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 119.791 Td /F1 9.8 Tf  [(Surge capacity development)] TJ ET
BT 161.014 119.791 Td /F1 9.8 Tf  [( within \(EA 33\) and )] TJ ET
BT 246.092 119.791 Td /F1 9.8 Tf  [(beyond healthcare facilities)] TJ ET
0.267 0.267 0.267 rg
BT 363.687 120.240 Td /F4 8.7 Tf  [(29)] TJ ET
BT 373.324 120.240 Td /F4 8.7 Tf  [(58)] TJ ET
BT 382.962 120.240 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 101.709 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 101.709 Td /F1 9.8 Tf  [(Issues in adjusting to crisis standards of care and maintaining priorities)] TJ ET
BT 343.075 101.709 Td /F1 9.8 Tf  [( \(EA 32 & EA 36a & EA 38i\) )] TJ ET
0.267 0.267 0.267 rg
BT 466.101 102.158 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 83.627 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 83.627 Td /F1 9.8 Tf  [(Safeguarding patient�s medical records)] TJ ET
BT 206.527 83.627 Td /F1 9.8 Tf  [( and medication needs \(EA 44a\) )] TJ ET
BT 348.516 83.627 Td /F1 9.8 Tf  [(during disaster)] TJ ET
0.267 0.267 0.267 rg
BT 412.456 84.076 Td /F4 8.7 Tf  [(48)] TJ ET
BT 422.094 84.076 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(Discussion of the literature evidence.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The WHO Toolkit provides a generic resource, enabling countries to increase the resilience of their health system to manage risks of disasters using an all-hazards approach. The qualitative analysis of the collated worldwide experience of disasters since 2000 provides a complementary literature-based approach to support and enhance the expert-consensus process used in the development of the Toolkit. The analysis has identified many priorities well represented in the Toolkit and a few areas that are under-represented.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Areas that are well represented in both the literature and the toolkit pertain to legal and governance structures for emergency management. These include prioritising national multisectoral coordination as well as health-sector emergency management. The importance of partnership-building is also recognised. Human resource development is another key component that is found in the Toolkit and widely discussed in the literature. This includes disaster training and education for health workers. Logistics and operational support for acute response delivery and the continuation of essential services during disasters are areas well represented in the Toolkit.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(A selection of under-represented areas is discussed below.)] TJ ET
BT 0.000 782.981 Td /F4 9.8 Tf  [(1\) Leadership and governance. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Interwoven nature of the legal system, ethical decision-making and disaster management.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The importance of explicitly including ethical decision-making processes in disaster management is not widespread in practice, nor mentioned in the Toolkit. For example, Thomas� survey of disaster planners in the United States of America found that both ethical training and expertise were lacking, and concludes that there is a �risk of making many unjust and regrettable decisions� The allocation of resources and the application of control measures have enormous ethical implications, not only in the saving of lives but also in the preservation of human rights, maintenance of a functioning society, and the achievement of social justice�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(25)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( The balance between individual rights versus public health benefits can be particularly difficult in times of crisis, such as the need to isolate or quarantine individuals to protect a wider population. It is important to prepare guidelines in advance so that they can be drawn upon at the time of a disaster without further delay or due consultation; transparency in decision-making is important.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Disaster management as a political issue.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Several authors concentrate on the involvement of political leaders due to the inherently political nature of decision-making during disasters � �Never has public health been more political or the linkages with government stronger or more demanding�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(28)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Hick argues that political authorities must be well-versed on issues, such as the allocation of scarce resources, and should be willing to trust the advice of public health and health care agencies )] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(. Political leaders determine what constitutes an �emergency�, and their laws determine issues regarding response, such as the extent of responsibility for potential or actual harms that occur as a result of the emergency.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(2\) Health workers. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Establishing the commitment and welfare of health workers.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Levin acknowledges that health workers are at risk of becoming infected early in a pandemic and emphasises the need to address their fears and concerns in advance, highlighting the survey finding that only 48% of health workers in the United States of America would currently report to work in such a scenario.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Health workers need to be confident that they will have access to all relevant protective equipment, vaccines, prophylaxis and treatments.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Barnett et al have explored this issue in relation to Public Health workers, and identify that rural cohorts are more willing to respond than urban based workers. They suggest that further investigation may identify factors that influence willingness to respond.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(60)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(3\) Health information. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Use of health information systems in disaster recovery.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Tools to support disaster recovery are important. An example is the �Dashboard Project� developed following Hurricane Katrina to produce demographic, economic and health indicators for the most severely affected areas, enabling ongoing disaster recovery.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(44)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Effective post-disaster surveillance can limit the risk of a further disasters caused by secondary causes. Infectious diseases, such as cholera or measles, can be catastrophic in vulnerable populations,)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(61)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( and mental health problems are common in the wake of disasters.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(47)] TJ ET
BT 0.000 783.983 Td /F4 8.7 Tf  [(62)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Geographic Information Systems can be used to support the identification of populations that will require resources and new services post-disaster, enhancing information provided by other surveillance systems.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Awareness of developments in health information tools.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( There is a need to improve health information systems so that they provide �rich patient data�, such as by increasing the range of data sources and undertaking real-time public health surveillance for emergency planning and response. Chretien suggests that tools should seek to enhance human judgment rather than replace it, allowing specific circumstances to be suitably analysed. There have been many developments in disaster management since 2000, but evaluations of information systems are lacking.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Communications � inter-agency; two-way with the public; and the role of the media as part of disaster management strategy.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The importance of crisis and risk communication is widely recognised in the literature. There are many levels at which communications must be rigorous during a crisis. For example, Dorn�s survey measures �connectivity� between disaster management agencies to evaluate public health preparedness and response.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Harris analysis �social networks� of public health disaster planners to reveal a paucity of networking with high-level and private-sector contacts, which the authors feel are necessary for managing an effective response to a disaster.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(46)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Klitzman recommends �early two-way communication \(with the public\)� to reduce distrust and maintain credibility�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Thus the media should be an integral part of the disaster strategy, with experts providing information.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( This ensures that messages are consistent, responsive, and can mitigate unnecessary anxiety.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(65)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(4\) Vaccinations. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Mass vaccination issues.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The literature describes significant controversy over examples of mass vaccination proposals.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(38)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Hupert models the likely demand on emergency health facilities as a direct result of adverse events following a mass vaccination program, finding that short vaccination campaigns would overwhelm capacity.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(39)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Noji considers that mass vaccination is rarely advisable, ineffectually diverting limited resources.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(40)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(However, each scenario must be independently judged as in certain circumstances failing to mass vaccinate against an infectious disease, such as measles, can have catastrophic consequences.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(66)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Public health consequences of technology failures and impact on healthcare facilities.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Prezant, using data showing that even back-up systems can be overwhelmed, suggests that public health disaster planning needs to include a wide spectrum of activities and training.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(43)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bluth describes the impact of power failure on medical technologies in a hospital department, rendering services crucial to the disaster response inadequate.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Public health consequences of a power failure, which may form only a part of a disaster, require contingency planning.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(42)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(5\) Finance systems. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Health finance system consequences on disaster management effectiveness and coordination. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(In times of crisis, issues relating to health finance and payment systems become acute.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(48)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Disaster preparedness requires clear policies that are effective regardless of the specific funding arrangements. However, conclusions from the literature emphasise that universal access to health care without out-of-pocket payment, facilitates earlier detection of new diseases, better enables disease-control and surveillance, and minimises detriment to population health caused by delayed care.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Further, in research conducted on pandemic influenza preparedness in Europe, Mournier-Jack concluded that health insurance providers should support plans to reach vaccine coverage thresholds and provide antiviral medications when required.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(6\) Service delivery. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Community preparedness strategies to increase community resilience. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Communities need to have a comprehensive planning process, a thorough emergency operations plan, established response capability, and an ongoing surveillance and notification system for communicating emergencies.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(53)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Matteson proposes the preparation of �home disaster kits� and information on �how to prepare a shelter at home during a pandemic�. The dissemination of these public health messages, they argue, �has the additional benefit of making the larger community aware of public health preparedness activities�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(57)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( These approaches are particularly important amongst communities that may lack resilience. Bouye concentrates on this issue, describing vulnerability as being as a result of �social and personal factors� confounded by system, policy and institutional factors�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(67)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( A community can become empowered and act as a �resource� rather than a �victim� following training in search and rescue, care and shelter, emergency communications, and so on.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(52)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Surge capacity development beyond healthcare facilities. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hick suggests expanding ambulatory care surge capacity to reduce pressure on hospitals, allowing them to concentrate on persons requiring higher levels of medical attention. The authors list a set of potential alternative care sites and factors to consider in the selection, while advocating the need to facilitate home family-based care.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( In support of home-care provision, Levin considers -�Placing large numbers of infected people in one congested \(alternative care site\) setting, which will probably have inadequate facilities for personal hygiene and sanitation, could serve to promote its spread and provide marginal care at best�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Issues in adjusting to crisis standards of care and maintaining priorities. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(The health system may become overwhelmed during a disaster requiring adjustments in standards of care and the triaged allocation of limited resources. Gostin defines crisis standards of care as �the optimal level of health care that can be delivered during a catastrophic event, requiring a substantial change in usual health care operations.� Protocols, previously prepared by experts via an evidence-based, peer-reviewed process, should be provided for use in a disaster to guide clinicians with decision-making.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Hick proposes a tiered system of resources and coordination mechanisms, in which an inadequacy of resources at one level \(such as community\) activates the next tier of response \(such as regional\), and so on.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( There should be an established system allowing for an immediate request for assistance from neighbouring regions, and arrangements for the transfer of patients. Legal mandates may be helpful in this regard, particularly with mutual aid agreements to transfer special care patients from a nursing home, hospice or with other chronic disease such as requiring kidney dialysis.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Safeguarding patient�s medical records and medication needs during disaster.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Several authors focus on the need to create central databases of patient�s medical histories and medications.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(48)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Arrieta highlights that patients generally lack knowledge about their medical history and thus advises that patients should be provided with summaries that can be distributed, with prescriptions linked to pharmacies with central databases.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(Implications for public health, policy and disaster management multi-professionals.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Using evidence and practical experience drawn from the published literature to complement the WHO Toolkit, planners from around the world can evaluate the status of their current health system in regard to disaster management. This information can help to identify the most effective developments to be made across all levers to enhance their preparedness and resilience to all-hazards disasters.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(This initial exploration provides scope for development. Future research should consider the usability and effectiveness of the health system strengthening approach across a range of low, middle and high income countries, each with their unique health system structures, environment and resource implications. The search of the core literature results in a bias towards the highly resourced United States of America, whilst the grey literature provides insights into disaster management in low-income countries. A variety of documents were included in the review, such as opinion pieces and case reports. These expose important areas of controversy and present useful, all be it specific, experiences in the field. The nature of disasters means that each incident can identify important lessons, and thus have been included in this collation.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(The changing climate is increasing threats, leading to �changes in the frequency, intensity, spatial extent, duration, and timing of extreme weather and climate events, and can result in unprecedented extreme weather and climate events�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(68)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( The impact is significant in large parts of the developing world where populations and health systems are already vulnerable, and disaster response management and infrastructure lacking. This work may be progressed to reduce health system vulnerabilities for these populations.)] TJ ET
BT 0.000 780.900 Td /F4 12.0 Tf  [(Conclusion)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Ministries and Departments of Health within countries should consider prioritising preparedness for their most likely threats, and yet plan for an all-hazards approach to disasters. Their governments have the ultimate responsibility to be able to train staff, manage a surge in need, conduct timely surveillance, prevent secondary consequences and minimise morbidity and mortality. Health agencies at the highest level need to be able to coordinate with other agencies, collaborate with other countries, communicate effectively amongst themselves and with the public, engage communities, build resilience and deliver an efficient recovery. This requires being abreast of developments in disaster management, accessing the most useful tools, with continuous planning and reflective research to identify lessons from past disasters. Previously there has been no database or collated resource of disaster management lessons, meaning that essential experience is being forgotten.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(In summary, the qualitative analysis of the disaster management experience found in the published literature supports the value and content of the WHO Toolkit by identifying lessons from the actual worldwide experience of disasters since 2000. In combination, this work sets out a health system strengthening approach to building disaster management capacity. It has international relevance and applicability, as highlighted by the recent World Health Assembly�s agenda item and WHO�s commitment to developing the health system approach to disaster management. This approach will contribute to sustainable health system resilience for populations in the face of disasters.)] TJ ET
BT 0.000 780.900 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(					Claire Bayntun is grateful to be funded by NIHR as an Academic Clinical Fellow in Public Health.The Department of Primary Care & Public Health at Imperial College London is grateful for support from the NIHR Collaboration for Leadership in Applied Health Research & Care \(CLAHRC\) Scheme, the NIHR Biomedical Research Centre scheme, and the Imperial Centre for Patient Safety and Service Quality. There are no conflicts of interest.				)] TJ ET
BT 0.000 780.900 Td /F4 12.0 Tf  [(References)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO. PAHO's Interactive Report of Cholera Outbreak. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(PAHO. Health response to the earthquake in Haiti 2010; Lessons to be learned for the next massive sudden-onset disaster. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Responding in a Crisis: The Role of National and International Health Workers � Lessons from Haiti: Merlin; 2010. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Pakistan Floods Progress Report July 2010 / July 2011: Oxfam; 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Public health risk assessment and interventions - The Horn of Africa: Drought and famine crisis ; 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Matsumoto M, Inoue K. Earthquake, tsunami, radiation leak, and crisis in rural health in Japan. Rural and Remote Health 2011;1759\(11\).)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Strengthening health-system emergency preparedness: Toolkit for Assessing Health System Capacity for Crisis Management. 2012)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 785.062 Td /F1 7.5 Tf  [(Reference Link)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Nelson, Lurie, Wasserman, Zakowski. Conceptualising and defining public health preparedness. Am J of PH 2007;97\(Suppl 1\):S9-11. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Assessment of health security and crises management. Armenia, Azerbaijan, Republic of Moldova. 2007-8. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Assessment of health systems crisis preparedness, Turkey. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Health Needs Assessment, Malta 2011. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Press Release: Conclusions of the health mission in Lampedusa. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Greece Mission Report 2011. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bayntun C. How can health system strengthening contribute to disaster management? A systematic review and qualitative analysis of the literatureWHO Collaborating Centre for Public Health Training & Education, Imperial College, London. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hyogo Framework for Action 2005-2015: Building the resilience of nations and communities to disasters; 2005. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bayntun C. A health system approach to all-hazards disaster management:A systematic review. Submitted for publication - 2012. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Harden A, Garcia J, Oliver S, Rees R, Shepherd J, Brunton G, et al. Applying systematic review methods to studies of people�s views: an example from public health research. Epidemiology & Community Health 2004;58:794-800. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Global Assessment of National Health Sector Emergency Preparedness and Response ; 2008. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Glaser BG, Strauss A. Discovery of Grounded Theory: Strategies for Qualitative Research : Sociology Press; 1967. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Mounier-Jack S, Coker RJ. How prepared is Europe for pandemic influenza? Analysis of national plans. Lancet 2006 Apr 29;367\(9520\):1405-1411. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Roffey R, Lantorp K, Tegnell A, Elgh F. Biological weapons and bioterrorism preparedness: Importance of public-health awareness and international cooperation. Clinical Microbiology and Infection 2002;8\(8\) \(pp 522-528\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Jones M, O'Carroll P, Thompson J, D'Ambrosio L. Assessing regional public health preparedness: A new tool for considering cross-border issues. Journal of Public Health Management and Practice 2008;14\(5 \(pp E15-E22\)\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Kahn LH, Barondess JA. Preparing for disaster: Response matrices in the USA and UK. Journal of Urban Health 2008;85\(6\) \(pp 910-922\).)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Barnett DJ, Taylor HA, Hodge JG,Jr, Links JM. Resource allocation on the frontlines of public health preparedness and response: report of a summit on legal and ethical issues. Public Health Rep 2009 Mar-Apr;124\(2\):295-303. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Thomas JC, Dasgupta N, Martinot A. Ethics in a pandemic: a survey of the state pandemic influenza plans. Am J Public Health 2007 Apr;97 Suppl 1:S26-31. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Wynia MK, Gostin LO. Ethical challenges in preparing for bioterrorism: barriers within the health care system. Am J Public Health 2004 Jul;94\(7\):1096-1102. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Gostin LO, Hanfling D. National preparedness for a catastrophic emergency: crisis standards of care. JAMA 2009 Dec 2;302\(21\):2365-2366. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Jacobs LM, Burns KJ, Gross RI. Terrorism: a public health threat with a trauma system response. J Trauma 2003 Dec;55\(6\):1014-1021. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hick JL, Hanfling D, Burstein JL, DeAtley C, Barbisch D, Bogdan GM, et al. Health care facility and community strategies for patient care surge capacity. Ann Emerg Med 2004 Sep;44\(3\):253-261. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Olson D, Hoeppner M, Larson S, Ehrenberg A, Leitheiser AT. Lifelong learning for public health practice education: a model curriculum for bioterrorism and emergency readiness. Public Health Rep 2008;123 Suppl 2:53-64. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Markenson D, DiMaggio C, Redlener I. Preparing health professions students for terrorism, disaster, and public health emergencies: core competencies. Acad Med 2005 Jun;80\(6\):517-526. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Fowkes V, Blossom HJ, Anderson HK, Sandrock C. Emergency Preparedness for Health Professionals in a Statewide AHEC Program: the first two years. Acad Med 2007 Aug;82\(8\):781-787. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Potter MA, Miner KR, Barnett DJ, Cadigan R, Lloyd L, Olson DK, et al. The evidence base for effectiveness of preparedness training: a retrospective analysis. Public Health Rep 2010 Nov-Dec;125\(Suppl 5\):15-23. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Biddinger PD, Savoia E, Massin-Short SB, Preston J, Stoto MA. Public health emergency preparedness exercises: lessons learned. Public Health Rep 2010 Nov-Dec;125\(Suppl 5\):100-106. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Levin PJ, Gebbie EN, Qureshi K. Can the health-care system meet the challenge of pandemic flu? Planning, ethical, and workforce considerations. Public Health Rep 2007 Sep-Oct;122\(5\):573-578. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Ziskin LZ, Harris DA. State health policy for terrorism preparedness. Am J Public Health 2007 Sep;97\(9\):1583-1588. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Massoomi F. Pharmacists in the Omaha Metropolitan Medical Response System. American Journal of Health-System Pharmacy 2005;62\(12\) \(pp 1290-1298\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Cohen HW, Gould RM, Sidel VW. The pitfalls of bioterrorism preparedness: the anthrax and smallpox experiences. Am J Public Health 2004 Oct;94\(10\):1667-1671. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hupert N, Wattson D, Cuomo J, Benson S. Anticipating Demand for Emergency Health Services due to Medication-related Adverse Events after Rapid Mass Prophylaxis Campaigns. Acad Emerg Med 2007;14\(3 \(pp 268-274\)\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Noji EK. Public health issues in disasters. Crit Care Med 2005 Jan;33\(1 Suppl\):S29-33. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bluth EI, Kay D, Smetherman D, DeVun D, Eick J, Matthews C, et al. Managing in a catastrophe: radiology during Hurricane Katrina. AJR Am J Roentgenol 2007 Mar;188\(3\):630-632. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Beatty ME, Phelps S, Rohner MC, Weisfuse MI. Blackout of 2003: public health effects and emergency response. Public Health Rep 2006 Jan-Feb;121\(1\):36-44. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Prezant DJ, Clair J, Belyaev S, Alleyne D, Banauch GI, Davitt M, et al. Effects of the August 2003 blackout on the New York City healthcare delivery system: a lesson for disaster preparedness. Crit Care Med 2005 Jan;33\(1 Suppl\):S96-101. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Stone G, Lekht A, Burris N, Williams C. Data collection and communications in the public health response to a disaster: Rapid population estimate surveys and the daily Dashboard in post-Katrina New Orleans. Journal of Public Health Management and Practice 2007;13\(5\) \(pp 453-460\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Chretien JP, Tomich NE, Gaydos JC, Kelley PW. Real-time public health surveillance for emergency preparedness. Am J Public Health 2009 Aug;99\(8\):1360-1363. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Harris JK, Clements B. Using social network analysis to understand Missouri's system of public health emergency planners. Public Health Rep 2007 Jul-Aug;122\(4\):488-498. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Klitzman S, Freudenberg N. Implications of the World Trade Center attack for the public health and health care infrastructures. Am J Public Health 2003 Mar;93\(3\):400-406. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Lurie N. H1N1 influenza, public health preparedness, and health care reform. N Engl J Med 2009 Aug 27;361\(9\):843-845. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Schmitt B, Dobrez D, Parada JP, Kyriacou DN, Golub RM, Sharma R, et al. Responding to a small-scale bioterrorist anthrax attack: Cost-effectiveness analysis comparing preattack vaccination with postattack antibiotic treatment and vaccination. Arch Intern Med 2007;167\(7\) \(pp 655-662\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Broz D, Levin EC, Mucha AP, Pelzel D, Wong W, Persky VW, et al. Lessons learned from Chicago's emergency response to mass evacuations caused by Hurricane Katrina. Am J Public Health 2009 Aug;99\(8\):1496-1504. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Keeney GB. Disaster preparedness: What do we do now?. Journal of Midwifery and Women's Health 2004;49\(4 Suppl.\) \(pp 2-6\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Lichterman JD. A "community as resource" strategy for disaster response. Public Health Rep 2000 Mar-Jun;115\(2-3\):262-265. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Braun BI, Wineman NV, Finn NL, Barbera JA, Schmaltz SP, Loeb JM. Integrating hospitals into community emergency preparedness planning. Ann Intern Med 2006 06 Jun 2006;144\(11\):799-811. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Davey VJ. Disaster care: questions and answers on pandemic influenza. Striking a balance between risk and preparedness. Am J Nurs 2007 Jul;107\(7\):50-6; quiz 57. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Biddinger PD, Cadigan RO, Auerbach BS, Burstein JL, Savoia E, Stoto MA, et al. On linkages: using exercises to identify systems-level preparedness challenges. Public Health Rep 2008 Jan-Feb;123\(1\):96-101. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hien LTT, Takano T, Seino K, Ohnishi M, Nakamura K. Effectiveness of a capacity-building program for community leaders in a healthy living environment: A randomized community-based intervention in rural Vietnam. Health Promot Internation 2008;23\(4 \(pp 354-364\)\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Matteson LM. Using seasonal influenza clinics for public health preparedness exercises. Am J Nurs 2006 Oct;106\(10\):28-29. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Eastman AL, Rinnert KJ, Nemeth IR, Fowler RL, Minei JP. Alternate site surge capacity in times of public health disaster maintains trauma center and emergency department integrity: Hurricane Katrina. J Trauma 2007 Aug;63\(2\):253-257. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Arrieta MI, Foreman RD, Crook ED, Icenogle ML. Insuring continuity of care for chronic disease patients after a disaster: key preparedness elements. Am J Med Sci 2008 Aug;336\(2\):128-133. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Barnett DJ, Thompson CB, Errett NA, Semon NL, Anderson MK, Ferrell JL, Freiheit JM, Hudson R, Koch MM, McKee M, Mejia-Echeverry A, Spitzer J, Balicer RD, Links JM. Determinants of emergency response willingness in the local public health workforce by jurisdictional and scenario patterns: a cross-sectional survey. BMC Public Health 2012;Mar 7;12:164. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Goma Epidemiology Group. Public health impact of Rwandan refugee crisis: what happened in Goma, Zaire, in July, 1994? Lancet 1995 Feb 11;345\(8946\):339-344.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Schoenbaum M, Butler B, Kataoka S, Norquist G, Springgate B, Sullivan G, et al. Promoting mental health recovery after hurricanes Katrina and Rita: what can be done at what cost. Arch Gen Psychiatry 2009 Aug;66\(8\):906-914. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Doocy S, Gorokhovich Y, Burnham G, Balk D, Robinson C. Tsunami mortality estimates and vulnerability mapping in Aceh, Indonesia. Am J Public Health 2007 Apr;97 Suppl 1:S146-51. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Dorn BC, Savoia E, Testa MA, Stoto MA, Marcus LJ. Development of a survey instrument to measure connectivity to evaluate national public health preparedness and response performance. Public Health Rep 2007 May-Jun;122\(3\):329-338. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hawryluck L, Lapinsky SE, Stewart TE. Clinical review: SARS - Lessons in disaster management. Critical Care 2005;9\(4\) \(pp 384-389\):ate of Pubaton: Aug 2005. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL. Communicable diseases in complex emergencies: impact and challenges. Lancet 2004;Nov 27-Dec 3;364\(9449\):1974-83. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bouye K, Truman BI, Hutchins S, Richard R, Brown C, Guillory JA, et al. Pandemic influenza preparedness and response among public-housing residents, single-parent families, and low-income populations. Am J Public Health 2009 Oct;99 Suppl 2:S287-93. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(IPCC. Managing the Risks of Extreme Events and Disasters to AdvanceClimate Change Adaptation - A Special Report of Working Group I and Working Group II of the Intergovernmental Panel on Climate Change. 2011. )] TJ ET
Q
q
15.000 31.636 577.500 745.364 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Panel 1 Health system priorities in all-hazards disaster management � with references)] TJ ET
Q
0.965 0.965 0.965 rg
26.250 722.588 555.000 33.175 re f
0.267 0.267 0.267 rg
0.267 0.267 0.267 RG
26.250 755.764 m 581.250 755.764 l 580.500 755.014 l 27.000 755.014 l  f
581.250 755.764 m 581.250 722.588 l 580.500 722.588 l 580.500 755.014 l  f
26.250 755.764 m 26.250 722.588 l 27.000 722.588 l 27.000 755.014 l  f
0.271 0.267 0.267 rg
BT 33.000 741.688 Td /F1 9.0 Tf  [(EA � Essential attribute reference from the Toolkit for assessing health-systems capacity for crisis management in the WHO Regional )] TJ ET
BT 33.000 732.042 Td /F1 9.0 Tf  [(Office for Europe )] TJ ET
0.267 0.267 0.267 rg
BT 103.533 732.456 Td /F4 8.0 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 107.981 732.042 Td /F1 9.0 Tf  [(. Underlined priorities highlight areas that are under-represented by the Toolkit, and are discussed further below)] TJ ET
1.000 1.000 1.000 rg
26.250 76.636 555.000 645.953 re f
0.267 0.267 0.267 rg
26.625 721.463 554.250 0.750 re f
26.625 636.205 0.750 86.008 re f
580.125 636.205 0.750 86.008 re f
0.271 0.267 0.267 rg
BT 31.875 704.108 Td /F4 9.8 Tf  [(1\) Leadership and governance)] TJ ET
BT 31.875 688.977 Td /F1 9.8 Tf  [(� International, national and cross-boundary systems of governance, coordination and response for all-hazards disasters )] TJ ET
BT 31.875 678.985 Td /F1 9.8 Tf  [(\(Toolkit essential attribute 1a & 2a\).)] TJ ET
0.267 0.267 0.267 rg
BT 185.233 679.434 Td /F4 8.7 Tf  [(20)] TJ ET
BT 194.870 679.434 Td /F4 8.7 Tf  [(21)] TJ ET
BT 204.507 679.434 Td /F4 8.7 Tf  [(22)] TJ ET
BT 214.145 679.434 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 660.903 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 660.903 Td /F1 9.8 Tf  [(Interwoven nature of the legal system, ethical decision-making)] TJ ET
BT 306.776 660.903 Td /F1 9.8 Tf  [( and disaster management \(EA 3d\). )] TJ ET
0.267 0.267 0.267 rg
BT 463.390 661.352 Td /F4 8.7 Tf  [(24)] TJ ET
BT 473.028 661.352 Td /F4 8.7 Tf  [(25)] TJ ET
BT 482.665 661.352 Td /F4 8.7 Tf  [(26)] TJ ET
BT 492.303 661.352 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 642.821 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 642.821 Td /F1 9.8 Tf  [(Disaster management as a political issue)] TJ ET
BT 215.185 642.821 Td /F1 9.8 Tf  [( requiring strong leadership skills \(EA 4d and EA 6d\). )] TJ ET
0.267 0.267 0.267 rg
BT 446.572 643.270 Td /F4 8.7 Tf  [(28)] TJ ET
BT 456.209 643.270 Td /F4 8.7 Tf  [(29)] TJ ET
26.625 636.205 554.250 0.750 re f
26.625 420.864 0.750 216.091 re f
580.125 420.864 0.750 216.091 re f
0.271 0.267 0.267 rg
BT 31.875 618.850 Td /F4 9.8 Tf  [(2\) Health workforce)] TJ ET
BT 31.875 601.358 Td /F1 9.8 Tf  [(� Public health training in disaster management and evaluation )] TJ ET
0.267 0.267 0.267 rg
BT 304.085 601.807 Td /F4 8.7 Tf  [(30)] TJ ET
BT 313.723 601.807 Td /F4 8.7 Tf  [(31)] TJ ET
BT 323.360 601.807 Td /F4 8.7 Tf  [(32)] TJ ET
BT 332.997 601.807 Td /F4 8.7 Tf  [(33)] TJ ET
BT 342.635 601.807 Td /F4 8.7 Tf  [(34)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 583.276 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 583.276 Td /F1 9.8 Tf  [(Establishing the commitment, welfare)] TJ ET
BT 199.468 583.276 Td /F1 9.8 Tf  [( and volunteer-credentialing)] TJ ET
BT 319.773 583.276 Td /F1 9.8 Tf  [( of health workers)] TJ ET
BT 396.720 583.276 Td /F1 9.8 Tf  [( \(EA 15c\). )] TJ ET
0.267 0.267 0.267 rg
BT 442.779 583.725 Td /F4 8.7 Tf  [(35)] TJ ET
BT 452.416 583.725 Td /F4 8.7 Tf  [(26)] TJ ET
26.625 420.864 554.250 0.750 re f
26.625 343.237 0.750 78.377 re f
580.125 343.237 0.750 78.377 re f
0.271 0.267 0.267 rg
BT 31.875 403.509 Td /F4 9.8 Tf  [(3\) Medical products, vaccines and technology)] TJ ET
BT 31.875 386.017 Td /F1 9.8 Tf  [(� Stockpiling disaster-related medications and equipment, and their distribution \(EA 17b, d & e, & EA 18 b, d & e\) )] TJ ET
0.267 0.267 0.267 rg
BT 519.775 386.466 Td /F4 8.7 Tf  [(29)] TJ ET
BT 529.412 386.466 Td /F4 8.7 Tf  [(36)] TJ ET
BT 539.049 386.466 Td /F4 8.7 Tf  [(37)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 367.935 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 367.935 Td /F1 9.8 Tf  [(Required characteristics for mass vaccination and understanding previous controversies)] TJ ET
BT 417.848 367.935 Td /F1 9.8 Tf  [( \(EA 18a\) )] TJ ET
0.267 0.267 0.267 rg
BT 461.743 368.384 Td /F4 8.7 Tf  [(38)] TJ ET
BT 471.380 368.384 Td /F4 8.7 Tf  [(39)] TJ ET
BT 481.017 368.384 Td /F4 8.7 Tf  [(40)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 349.853 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 349.853 Td /F1 9.8 Tf  [(Public health consequences of technology failures)] TJ ET
BT 254.233 349.853 Td /F1 9.8 Tf  [( and impact on healthcare facilities \(EA 39b & c, & EA 51\) )] TJ ET
0.267 0.267 0.267 rg
BT 505.686 350.302 Td /F4 8.7 Tf  [(41)] TJ ET
BT 515.323 350.302 Td /F4 8.7 Tf  [(42)] TJ ET
BT 524.961 350.302 Td /F4 8.7 Tf  [(43)] TJ ET
26.625 343.237 554.250 0.750 re f
26.625 250.347 0.750 93.640 re f
580.125 250.347 0.750 93.640 re f
0.271 0.267 0.267 rg
BT 31.875 325.882 Td /F4 9.8 Tf  [(4\) Health information)] TJ ET
BT 31.875 310.751 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 310.751 Td /F1 9.8 Tf  [(Requirement to optimize the performance of health information)] TJ ET
BT 308.404 310.751 Td /F1 9.8 Tf  [( at all stages of disaster planning \(EA 21a & c, & EA 23a & )] TJ ET
BT 31.875 300.759 Td /F1 9.8 Tf  [(b\), management \(EA 22b & 24\) and )] TJ ET
BT 188.499 300.759 Td /F1 9.8 Tf  [(recovery)] TJ ET
BT 225.880 300.759 Td /F1 9.8 Tf  [( \(EA 24\) )] TJ ET
0.267 0.267 0.267 rg
BT 264.354 301.208 Td /F4 8.7 Tf  [(44)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 282.677 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 282.677 Td /F1 9.8 Tf  [(Awareness of research and developments in health information tools)] TJ ET
0.267 0.267 0.267 rg
BT 333.881 283.126 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 266.955 Td /F1 9.8 Tf  [(� Communications �)] TJ ET
BT 118.728 266.955 Td /F1 9.8 Tf  [( inter-agency; two-way with the public)] TJ ET
BT 280.744 266.955 Td /F1 9.8 Tf  [(; and the )] TJ ET
BT 321.401 266.955 Td /F1 9.8 Tf  [(role of the media)] TJ ET
BT 394.019 266.955 Td /F1 9.8 Tf  [( as part of disaster management strategy )] TJ ET
BT 31.875 256.964 Td /F1 9.8 Tf  [(\(EA 28b,c & d\) )] TJ ET
0.267 0.267 0.267 rg
BT 97.990 257.413 Td /F4 8.7 Tf  [(46)] TJ ET
BT 107.627 257.413 Td /F4 8.7 Tf  [(28)] TJ ET
BT 117.264 257.413 Td /F4 8.7 Tf  [(47)] TJ ET
BT 126.902 257.413 Td /F4 8.7 Tf  [(23)] TJ ET
26.625 250.347 554.250 0.750 re f
26.625 190.802 0.750 60.295 re f
580.125 190.802 0.750 60.295 re f
0.271 0.267 0.267 rg
BT 31.875 232.992 Td /F4 9.8 Tf  [(5\) Health financing)] TJ ET
BT 31.875 215.500 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 215.500 Td /F1 9.8 Tf  [(Health finance system consequences on disaster management effectiveness and coordination)] TJ ET
BT 443.900 215.500 Td /F1 9.8 Tf  [( \(EA 31\) )] TJ ET
0.267 0.267 0.267 rg
BT 482.374 215.949 Td /F4 8.7 Tf  [(48)] TJ ET
BT 492.011 215.949 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 197.418 Td /F1 9.8 Tf  [(� Disaster management funding issues; implications for national public � and global � health \(EA 30 & 31\) )] TJ ET
0.267 0.267 0.267 rg
BT 488.331 197.867 Td /F4 8.7 Tf  [(38)] TJ ET
BT 497.968 197.867 Td /F4 8.7 Tf  [(49)] TJ ET
26.625 190.802 554.250 0.750 re f
26.625 77.011 554.250 0.750 re f
26.625 77.011 0.750 114.541 re f
580.125 77.011 0.750 114.541 re f
0.271 0.267 0.267 rg
BT 31.875 173.447 Td /F4 9.8 Tf  [(6\) Service delivery)] TJ ET
BT 31.875 155.955 Td /F1 9.8 Tf  [(� Disaster preparedness \(EA 32\), acute response \(EA 34\) and continuing service requirements \(EA 39 & EA 51\) )] TJ ET
0.267 0.267 0.267 rg
BT 515.953 156.404 Td /F4 8.7 Tf  [(50)] TJ ET
BT 525.590 156.404 Td /F4 8.7 Tf  [(40)] TJ ET
BT 535.227 156.404 Td /F4 8.7 Tf  [(51)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 137.873 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 137.873 Td /F1 9.8 Tf  [(Community preparedness strategies to increase community resilience)] TJ ET
0.267 0.267 0.267 rg
BT 338.717 138.322 Td /F4 8.7 Tf  [(52)] TJ ET
BT 348.355 138.322 Td /F4 8.7 Tf  [(53)] TJ ET
BT 357.992 138.322 Td /F4 8.7 Tf  [(54)] TJ ET
BT 367.629 138.322 Td /F4 8.7 Tf  [(55)] TJ ET
BT 377.267 138.322 Td /F4 8.7 Tf  [(56)] TJ ET
BT 386.904 138.322 Td /F4 8.7 Tf  [(57)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 119.791 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 119.791 Td /F1 9.8 Tf  [(Surge capacity development)] TJ ET
BT 161.014 119.791 Td /F1 9.8 Tf  [( within \(EA 33\) and )] TJ ET
BT 246.092 119.791 Td /F1 9.8 Tf  [(beyond healthcare facilities)] TJ ET
0.267 0.267 0.267 rg
BT 363.687 120.240 Td /F4 8.7 Tf  [(29)] TJ ET
BT 373.324 120.240 Td /F4 8.7 Tf  [(58)] TJ ET
BT 382.962 120.240 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 101.709 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 101.709 Td /F1 9.8 Tf  [(Issues in adjusting to crisis standards of care and maintaining priorities)] TJ ET
BT 343.075 101.709 Td /F1 9.8 Tf  [( \(EA 32 & EA 36a & EA 38i\) )] TJ ET
0.267 0.267 0.267 rg
BT 466.101 102.158 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 83.627 Td /F1 9.8 Tf  [(� )] TJ ET
BT 37.998 83.627 Td /F1 9.8 Tf  [(Safeguarding patient�s medical records)] TJ ET
BT 206.527 83.627 Td /F1 9.8 Tf  [( and medication needs \(EA 44a\) )] TJ ET
BT 348.516 83.627 Td /F1 9.8 Tf  [(during disaster)] TJ ET
0.267 0.267 0.267 rg
BT 412.456 84.076 Td /F4 8.7 Tf  [(48)] TJ ET
BT 422.094 84.076 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(Discussion of the literature evidence.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The WHO Toolkit provides a generic resource, enabling countries to increase the resilience of their health system to manage risks of disasters using an all-hazards approach. The qualitative analysis of the collated worldwide experience of disasters since 2000 provides a complementary literature-based approach to support and enhance the expert-consensus process used in the development of the Toolkit. The analysis has identified many priorities well represented in the Toolkit and a few areas that are under-represented.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Areas that are well represented in both the literature and the toolkit pertain to legal and governance structures for emergency management. These include prioritising national multisectoral coordination as well as health-sector emergency management. The importance of partnership-building is also recognised. Human resource development is another key component that is found in the Toolkit and widely discussed in the literature. This includes disaster training and education for health workers. Logistics and operational support for acute response delivery and the continuation of essential services during disasters are areas well represented in the Toolkit.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(A selection of under-represented areas is discussed below.)] TJ ET
BT 0.000 782.981 Td /F4 9.8 Tf  [(1\) Leadership and governance. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Interwoven nature of the legal system, ethical decision-making and disaster management.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The importance of explicitly including ethical decision-making processes in disaster management is not widespread in practice, nor mentioned in the Toolkit. For example, Thomas� survey of disaster planners in the United States of America found that both ethical training and expertise were lacking, and concludes that there is a �risk of making many unjust and regrettable decisions� The allocation of resources and the application of control measures have enormous ethical implications, not only in the saving of lives but also in the preservation of human rights, maintenance of a functioning society, and the achievement of social justice�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(25)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( The balance between individual rights versus public health benefits can be particularly difficult in times of crisis, such as the need to isolate or quarantine individuals to protect a wider population. It is important to prepare guidelines in advance so that they can be drawn upon at the time of a disaster without further delay or due consultation; transparency in decision-making is important.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Disaster management as a political issue.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Several authors concentrate on the involvement of political leaders due to the inherently political nature of decision-making during disasters � �Never has public health been more political or the linkages with government stronger or more demanding�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(28)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Hick argues that political authorities must be well-versed on issues, such as the allocation of scarce resources, and should be willing to trust the advice of public health and health care agencies )] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(. Political leaders determine what constitutes an �emergency�, and their laws determine issues regarding response, such as the extent of responsibility for potential or actual harms that occur as a result of the emergency.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(2\) Health workers. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Establishing the commitment and welfare of health workers.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Levin acknowledges that health workers are at risk of becoming infected early in a pandemic and emphasises the need to address their fears and concerns in advance, highlighting the survey finding that only 48% of health workers in the United States of America would currently report to work in such a scenario.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Health workers need to be confident that they will have access to all relevant protective equipment, vaccines, prophylaxis and treatments.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Barnett et al have explored this issue in relation to Public Health workers, and identify that rural cohorts are more willing to respond than urban based workers. They suggest that further investigation may identify factors that influence willingness to respond.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(60)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(3\) Health information. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Use of health information systems in disaster recovery.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Tools to support disaster recovery are important. An example is the �Dashboard Project� developed following Hurricane Katrina to produce demographic, economic and health indicators for the most severely affected areas, enabling ongoing disaster recovery.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(44)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Effective post-disaster surveillance can limit the risk of a further disasters caused by secondary causes. Infectious diseases, such as cholera or measles, can be catastrophic in vulnerable populations,)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(61)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( and mental health problems are common in the wake of disasters.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(47)] TJ ET
BT 0.000 783.983 Td /F4 8.7 Tf  [(62)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Geographic Information Systems can be used to support the identification of populations that will require resources and new services post-disaster, enhancing information provided by other surveillance systems.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Awareness of developments in health information tools.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( There is a need to improve health information systems so that they provide �rich patient data�, such as by increasing the range of data sources and undertaking real-time public health surveillance for emergency planning and response. Chretien suggests that tools should seek to enhance human judgment rather than replace it, allowing specific circumstances to be suitably analysed. There have been many developments in disaster management since 2000, but evaluations of information systems are lacking.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Communications � inter-agency; two-way with the public; and the role of the media as part of disaster management strategy.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The importance of crisis and risk communication is widely recognised in the literature. There are many levels at which communications must be rigorous during a crisis. For example, Dorn�s survey measures �connectivity� between disaster management agencies to evaluate public health preparedness and response.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Harris analysis �social networks� of public health disaster planners to reveal a paucity of networking with high-level and private-sector contacts, which the authors feel are necessary for managing an effective response to a disaster.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(46)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Klitzman recommends �early two-way communication \(with the public\)� to reduce distrust and maintain credibility�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Thus the media should be an integral part of the disaster strategy, with experts providing information.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( This ensures that messages are consistent, responsive, and can mitigate unnecessary anxiety.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(65)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(4\) Vaccinations. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Mass vaccination issues.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( The literature describes significant controversy over examples of mass vaccination proposals.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(38)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Hupert models the likely demand on emergency health facilities as a direct result of adverse events following a mass vaccination program, finding that short vaccination campaigns would overwhelm capacity.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(39)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Noji considers that mass vaccination is rarely advisable, ineffectually diverting limited resources.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(40)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(However, each scenario must be independently judged as in certain circumstances failing to mass vaccinate against an infectious disease, such as measles, can have catastrophic consequences.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(66)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Public health consequences of technology failures and impact on healthcare facilities.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Prezant, using data showing that even back-up systems can be overwhelmed, suggests that public health disaster planning needs to include a wide spectrum of activities and training.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(43)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bluth describes the impact of power failure on medical technologies in a hospital department, rendering services crucial to the disaster response inadequate.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Public health consequences of a power failure, which may form only a part of a disaster, require contingency planning.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(42)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(5\) Finance systems. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Health finance system consequences on disaster management effectiveness and coordination. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(In times of crisis, issues relating to health finance and payment systems become acute.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(48)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Disaster preparedness requires clear policies that are effective regardless of the specific funding arrangements. However, conclusions from the literature emphasise that universal access to health care without out-of-pocket payment, facilitates earlier detection of new diseases, better enables disease-control and surveillance, and minimises detriment to population health caused by delayed care.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Further, in research conducted on pandemic influenza preparedness in Europe, Mournier-Jack concluded that health insurance providers should support plans to reach vaccine coverage thresholds and provide antiviral medications when required.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(6\) Service delivery. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Community preparedness strategies to increase community resilience. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Communities need to have a comprehensive planning process, a thorough emergency operations plan, established response capability, and an ongoing surveillance and notification system for communicating emergencies.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(53)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Matteson proposes the preparation of �home disaster kits� and information on �how to prepare a shelter at home during a pandemic�. The dissemination of these public health messages, they argue, �has the additional benefit of making the larger community aware of public health preparedness activities�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(57)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( These approaches are particularly important amongst communities that may lack resilience. Bouye concentrates on this issue, describing vulnerability as being as a result of �social and personal factors� confounded by system, policy and institutional factors�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(67)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( A community can become empowered and act as a �resource� rather than a �victim� following training in search and rescue, care and shelter, emergency communications, and so on.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(52)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Surge capacity development beyond healthcare facilities. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hick suggests expanding ambulatory care surge capacity to reduce pressure on hospitals, allowing them to concentrate on persons requiring higher levels of medical attention. The authors list a set of potential alternative care sites and factors to consider in the selection, while advocating the need to facilitate home family-based care.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( In support of home-care provision, Levin considers -�Placing large numbers of infected people in one congested \(alternative care site\) setting, which will probably have inadequate facilities for personal hygiene and sanitation, could serve to promote its spread and provide marginal care at best�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Issues in adjusting to crisis standards of care and maintaining priorities. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(The health system may become overwhelmed during a disaster requiring adjustments in standards of care and the triaged allocation of limited resources. Gostin defines crisis standards of care as �the optimal level of health care that can be delivered during a catastrophic event, requiring a substantial change in usual health care operations.� Protocols, previously prepared by experts via an evidence-based, peer-reviewed process, should be provided for use in a disaster to guide clinicians with decision-making.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Hick proposes a tiered system of resources and coordination mechanisms, in which an inadequacy of resources at one level \(such as community\) activates the next tier of response \(such as regional\), and so on.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( There should be an established system allowing for an immediate request for assistance from neighbouring regions, and arrangements for the transfer of patients. Legal mandates may be helpful in this regard, particularly with mutual aid agreements to transfer special care patients from a nursing home, hospice or with other chronic disease such as requiring kidney dialysis.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Safeguarding patient�s medical records and medication needs during disaster.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Several authors focus on the need to create central databases of patient�s medical histories and medications.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(48)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( Arrieta highlights that patients generally lack knowledge about their medical history and thus advises that patients should be provided with summaries that can be distributed, with prescriptions linked to pharmacies with central databases.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F4 9.8 Tf  [(Implications for public health, policy and disaster management multi-professionals.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [( Using evidence and practical experience drawn from the published literature to complement the WHO Toolkit, planners from around the world can evaluate the status of their current health system in regard to disaster management. This information can help to identify the most effective developments to be made across all levers to enhance their preparedness and resilience to all-hazards disasters.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(This initial exploration provides scope for development. Future research should consider the usability and effectiveness of the health system strengthening approach across a range of low, middle and high income countries, each with their unique health system structures, environment and resource implications. The search of the core literature results in a bias towards the highly resourced United States of America, whilst the grey literature provides insights into disaster management in low-income countries. A variety of documents were included in the review, such as opinion pieces and case reports. These expose important areas of controversy and present useful, all be it specific, experiences in the field. The nature of disasters means that each incident can identify important lessons, and thus have been included in this collation.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(The changing climate is increasing threats, leading to �changes in the frequency, intensity, spatial extent, duration, and timing of extreme weather and climate events, and can result in unprecedented extreme weather and climate events�.)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 783.983 Td /F4 8.7 Tf  [(68)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [( The impact is significant in large parts of the developing world where populations and health systems are already vulnerable, and disaster response management and infrastructure lacking. This work may be progressed to reduce health system vulnerabilities for these populations.)] TJ ET
BT 0.000 780.900 Td /F4 12.0 Tf  [(Conclusion)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Ministries and Departments of Health within countries should consider prioritising preparedness for their most likely threats, and yet plan for an all-hazards approach to disasters. Their governments have the ultimate responsibility to be able to train staff, manage a surge in need, conduct timely surveillance, prevent secondary consequences and minimise morbidity and mortality. Health agencies at the highest level need to be able to coordinate with other agencies, collaborate with other countries, communicate effectively amongst themselves and with the public, engage communities, build resilience and deliver an efficient recovery. This requires being abreast of developments in disaster management, accessing the most useful tools, with continuous planning and reflective research to identify lessons from past disasters. Previously there has been no database or collated resource of disaster management lessons, meaning that essential experience is being forgotten.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(In summary, the qualitative analysis of the disaster management experience found in the published literature supports the value and content of the WHO Toolkit by identifying lessons from the actual worldwide experience of disasters since 2000. In combination, this work sets out a health system strengthening approach to building disaster management capacity. It has international relevance and applicability, as highlighted by the recent World Health Assembly�s agenda item and WHO�s commitment to developing the health system approach to disaster management. This approach will contribute to sustainable health system resilience for populations in the face of disasters.)] TJ ET
BT 0.000 780.900 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(					Claire Bayntun is grateful to be funded by NIHR as an Academic Clinical Fellow in Public Health.The Department of Primary Care & Public Health at Imperial College London is grateful for support from the NIHR Collaboration for Leadership in Applied Health Research & Care \(CLAHRC\) Scheme, the NIHR Biomedical Research Centre scheme, and the Imperial Centre for Patient Safety and Service Quality. There are no conflicts of interest.				)] TJ ET
BT 0.000 780.900 Td /F4 12.0 Tf  [(References)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO. PAHO's Interactive Report of Cholera Outbreak. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(PAHO. Health response to the earthquake in Haiti 2010; Lessons to be learned for the next massive sudden-onset disaster. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Responding in a Crisis: The Role of National and International Health Workers � Lessons from Haiti: Merlin; 2010. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Pakistan Floods Progress Report July 2010 / July 2011: Oxfam; 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Public health risk assessment and interventions - The Horn of Africa: Drought and famine crisis ; 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Matsumoto M, Inoue K. Earthquake, tsunami, radiation leak, and crisis in rural health in Japan. Rural and Remote Health 2011;1759\(11\).)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Strengthening health-system emergency preparedness: Toolkit for Assessing Health System Capacity for Crisis Management. 2012)] TJ ET
0.267 0.267 0.267 rg
BT 0.000 785.062 Td /F1 7.5 Tf  [(Reference Link)] TJ ET
0.271 0.267 0.267 rg
BT 0.000 782.981 Td /F1 9.8 Tf  [(Nelson, Lurie, Wasserman, Zakowski. Conceptualising and defining public health preparedness. Am J of PH 2007;97\(Suppl 1\):S9-11. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Assessment of health security and crises management. Armenia, Azerbaijan, Republic of Moldova. 2007-8. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Assessment of health systems crisis preparedness, Turkey. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Health Needs Assessment, Malta 2011. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Press Release: Conclusions of the health mission in Lampedusa. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(WHO Regional Office for Europe. Greece Mission Report 2011. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bayntun C. How can health system strengthening contribute to disaster management? A systematic review and qualitative analysis of the literatureWHO Collaborating Centre for Public Health Training & Education, Imperial College, London. 2011. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hyogo Framework for Action 2005-2015: Building the resilience of nations and communities to disasters; 2005. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bayntun C. A health system approach to all-hazards disaster management:A systematic review. Submitted for publication - 2012. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Harden A, Garcia J, Oliver S, Rees R, Shepherd J, Brunton G, et al. Applying systematic review methods to studies of people�s views: an example from public health research. Epidemiology & Community Health 2004;58:794-800. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Global Assessment of National Health Sector Emergency Preparedness and Response ; 2008. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Glaser BG, Strauss A. Discovery of Grounded Theory: Strategies for Qualitative Research : Sociology Press; 1967. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Mounier-Jack S, Coker RJ. How prepared is Europe for pandemic influenza? Analysis of national plans. Lancet 2006 Apr 29;367\(9520\):1405-1411. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Roffey R, Lantorp K, Tegnell A, Elgh F. Biological weapons and bioterrorism preparedness: Importance of public-health awareness and international cooperation. Clinical Microbiology and Infection 2002;8\(8\) \(pp 522-528\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Jones M, O'Carroll P, Thompson J, D'Ambrosio L. Assessing regional public health preparedness: A new tool for considering cross-border issues. Journal of Public Health Management and Practice 2008;14\(5 \(pp E15-E22\)\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Kahn LH, Barondess JA. Preparing for disaster: Response matrices in the USA and UK. Journal of Urban Health 2008;85\(6\) \(pp 910-922\).)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Barnett DJ, Taylor HA, Hodge JG,Jr, Links JM. Resource allocation on the frontlines of public health preparedness and response: report of a summit on legal and ethical issues. Public Health Rep 2009 Mar-Apr;124\(2\):295-303. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Thomas JC, Dasgupta N, Martinot A. Ethics in a pandemic: a survey of the state pandemic influenza plans. Am J Public Health 2007 Apr;97 Suppl 1:S26-31. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Wynia MK, Gostin LO. Ethical challenges in preparing for bioterrorism: barriers within the health care system. Am J Public Health 2004 Jul;94\(7\):1096-1102. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Gostin LO, Hanfling D. National preparedness for a catastrophic emergency: crisis standards of care. JAMA 2009 Dec 2;302\(21\):2365-2366. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Jacobs LM, Burns KJ, Gross RI. Terrorism: a public health threat with a trauma system response. J Trauma 2003 Dec;55\(6\):1014-1021. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hick JL, Hanfling D, Burstein JL, DeAtley C, Barbisch D, Bogdan GM, et al. Health care facility and community strategies for patient care surge capacity. Ann Emerg Med 2004 Sep;44\(3\):253-261. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Olson D, Hoeppner M, Larson S, Ehrenberg A, Leitheiser AT. Lifelong learning for public health practice education: a model curriculum for bioterrorism and emergency readiness. Public Health Rep 2008;123 Suppl 2:53-64. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Markenson D, DiMaggio C, Redlener I. Preparing health professions students for terrorism, disaster, and public health emergencies: core competencies. Acad Med 2005 Jun;80\(6\):517-526. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Fowkes V, Blossom HJ, Anderson HK, Sandrock C. Emergency Preparedness for Health Professionals in a Statewide AHEC Program: the first two years. Acad Med 2007 Aug;82\(8\):781-787. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Potter MA, Miner KR, Barnett DJ, Cadigan R, Lloyd L, Olson DK, et al. The evidence base for effectiveness of preparedness training: a retrospective analysis. Public Health Rep 2010 Nov-Dec;125\(Suppl 5\):15-23. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Biddinger PD, Savoia E, Massin-Short SB, Preston J, Stoto MA. Public health emergency preparedness exercises: lessons learned. Public Health Rep 2010 Nov-Dec;125\(Suppl 5\):100-106. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Levin PJ, Gebbie EN, Qureshi K. Can the health-care system meet the challenge of pandemic flu? Planning, ethical, and workforce considerations. Public Health Rep 2007 Sep-Oct;122\(5\):573-578. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Ziskin LZ, Harris DA. State health policy for terrorism preparedness. Am J Public Health 2007 Sep;97\(9\):1583-1588. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Massoomi F. Pharmacists in the Omaha Metropolitan Medical Response System. American Journal of Health-System Pharmacy 2005;62\(12\) \(pp 1290-1298\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Cohen HW, Gould RM, Sidel VW. The pitfalls of bioterrorism preparedness: the anthrax and smallpox experiences. Am J Public Health 2004 Oct;94\(10\):1667-1671. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hupert N, Wattson D, Cuomo J, Benson S. Anticipating Demand for Emergency Health Services due to Medication-related Adverse Events after Rapid Mass Prophylaxis Campaigns. Acad Emerg Med 2007;14\(3 \(pp 268-274\)\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Noji EK. Public health issues in disasters. Crit Care Med 2005 Jan;33\(1 Suppl\):S29-33. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bluth EI, Kay D, Smetherman D, DeVun D, Eick J, Matthews C, et al. Managing in a catastrophe: radiology during Hurricane Katrina. AJR Am J Roentgenol 2007 Mar;188\(3\):630-632. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Beatty ME, Phelps S, Rohner MC, Weisfuse MI. Blackout of 2003: public health effects and emergency response. Public Health Rep 2006 Jan-Feb;121\(1\):36-44. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Prezant DJ, Clair J, Belyaev S, Alleyne D, Banauch GI, Davitt M, et al. Effects of the August 2003 blackout on the New York City healthcare delivery system: a lesson for disaster preparedness. Crit Care Med 2005 Jan;33\(1 Suppl\):S96-101. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Stone G, Lekht A, Burris N, Williams C. Data collection and communications in the public health response to a disaster: Rapid population estimate surveys and the daily Dashboard in post-Katrina New Orleans. Journal of Public Health Management and Practice 2007;13\(5\) \(pp 453-460\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Chretien JP, Tomich NE, Gaydos JC, Kelley PW. Real-time public health surveillance for emergency preparedness. Am J Public Health 2009 Aug;99\(8\):1360-1363. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Harris JK, Clements B. Using social network analysis to understand Missouri's system of public health emergency planners. Public Health Rep 2007 Jul-Aug;122\(4\):488-498. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Klitzman S, Freudenberg N. Implications of the World Trade Center attack for the public health and health care infrastructures. Am J Public Health 2003 Mar;93\(3\):400-406. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Lurie N. H1N1 influenza, public health preparedness, and health care reform. N Engl J Med 2009 Aug 27;361\(9\):843-845. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Schmitt B, Dobrez D, Parada JP, Kyriacou DN, Golub RM, Sharma R, et al. Responding to a small-scale bioterrorist anthrax attack: Cost-effectiveness analysis comparing preattack vaccination with postattack antibiotic treatment and vaccination. Arch Intern Med 2007;167\(7\) \(pp 655-662\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Broz D, Levin EC, Mucha AP, Pelzel D, Wong W, Persky VW, et al. Lessons learned from Chicago's emergency response to mass evacuations caused by Hurricane Katrina. Am J Public Health 2009 Aug;99\(8\):1496-1504. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Keeney GB. Disaster preparedness: What do we do now?. Journal of Midwifery and Women's Health 2004;49\(4 Suppl.\) \(pp 2-6\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Lichterman JD. A "community as resource" strategy for disaster response. Public Health Rep 2000 Mar-Jun;115\(2-3\):262-265. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Braun BI, Wineman NV, Finn NL, Barbera JA, Schmaltz SP, Loeb JM. Integrating hospitals into community emergency preparedness planning. Ann Intern Med 2006 06 Jun 2006;144\(11\):799-811. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Davey VJ. Disaster care: questions and answers on pandemic influenza. Striking a balance between risk and preparedness. Am J Nurs 2007 Jul;107\(7\):50-6; quiz 57. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Biddinger PD, Cadigan RO, Auerbach BS, Burstein JL, Savoia E, Stoto MA, et al. On linkages: using exercises to identify systems-level preparedness challenges. Public Health Rep 2008 Jan-Feb;123\(1\):96-101. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hien LTT, Takano T, Seino K, Ohnishi M, Nakamura K. Effectiveness of a capacity-building program for community leaders in a healthy living environment: A randomized community-based intervention in rural Vietnam. Health Promot Internation 2008;23\(4 \(pp 354-364\)\). )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Matteson LM. Using seasonal influenza clinics for public health preparedness exercises. Am J Nurs 2006 Oct;106\(10\):28-29. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Eastman AL, Rinnert KJ, Nemeth IR, Fowler RL, Minei JP. Alternate site surge capacity in times of public health disaster maintains trauma center and emergency department integrity: Hurricane Katrina. J Trauma 2007 Aug;63\(2\):253-257. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Arrieta MI, Foreman RD, Crook ED, Icenogle ML. Insuring continuity of care for chronic disease patients after a disaster: key preparedness elements. Am J Med Sci 2008 Aug;336\(2\):128-133. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Barnett DJ, Thompson CB, Errett NA, Semon NL, Anderson MK, Ferrell JL, Freiheit JM, Hudson R, Koch MM, McKee M, Mejia-Echeverry A, Spitzer J, Balicer RD, Links JM. Determinants of emergency response willingness in the local public health workforce by jurisdictional and scenario patterns: a cross-sectional survey. BMC Public Health 2012;Mar 7;12:164. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Goma Epidemiology Group. Public health impact of Rwandan refugee crisis: what happened in Goma, Zaire, in July, 1994? Lancet 1995 Feb 11;345\(8946\):339-344.)] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Schoenbaum M, Butler B, Kataoka S, Norquist G, Springgate B, Sullivan G, et al. Promoting mental health recovery after hurricanes Katrina and Rita: what can be done at what cost. Arch Gen Psychiatry 2009 Aug;66\(8\):906-914. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Doocy S, Gorokhovich Y, Burnham G, Balk D, Robinson C. Tsunami mortality estimates and vulnerability mapping in Aceh, Indonesia. Am J Public Health 2007 Apr;97 Suppl 1:S146-51. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Dorn BC, Savoia E, Testa MA, Stoto MA, Marcus LJ. Development of a survey instrument to measure connectivity to evaluate national public health preparedness and response performance. Public Health Rep 2007 May-Jun;122\(3\):329-338. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Hawryluck L, Lapinsky SE, Stewart TE. Clinical review: SARS - Lessons in disaster management. Critical Care 2005;9\(4\) \(pp 384-389\):ate of Pubaton: Aug 2005. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL. Communicable diseases in complex emergencies: impact and challenges. Lancet 2004;Nov 27-Dec 3;364\(9449\):1974-83. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(Bouye K, Truman BI, Hutchins S, Richard R, Brown C, Guillory JA, et al. Pandemic influenza preparedness and response among public-housing residents, single-parent families, and low-income populations. Am J Public Health 2009 Oct;99 Suppl 2:S287-93. )] TJ ET
BT 0.000 782.981 Td /F1 9.8 Tf  [(IPCC. Managing the Risks of Extreme Events and Disasters to AdvanceClimate Change Adaptation - A Special Report of Working Group I and Working Group II of the Intergovernmental Panel on Climate Change. 2011. )] TJ ET
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BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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trailer
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