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Early identification and separation of suspected Covid-19 patients at triage is vital to prevent disease transmission in healthcare settings. Triaging is a complex and context-specific process to implement especially where resources are scarce and health systems are fragile. The need to allocate these resources in a consistent, transparent, and equitable manner during the covid-19 pandemic is underpinned by ethical principles among which are utilitarianism and egalitarianism. Considerations of social identities such as age, gender, social class, and medical criteria such as comorbidities and frailty may lead to explicit and implicit bias and attendant discrimination. Theoretical constructs such as narrow social utility and reciprocity may be invoked to justify the prioritisation of healthcare workers (HCWs) infected with Covid-19 despite the pitfalls in the underlying assumptions. As no single framework exists to comprehensively guide the Covid-19 triage process, the establishment of institutional recommendations and policies within which are embedded safety nets for managing the physical, mental, and emotional fallouts on HCWs is critical.

This chapter shows that it is important to avoid descending to either an extreme of naturalizing disasters or sociologizing them. Safety depends on the appropriateness of social constructions for nature's constructions, whether inadvertent or based on sophisticated risk assessment. Worse-case scenarios need to be taken into account even if improbable, because assessments of their probability and timing have serious limitations. This chapter demonstrates that modern technology and organization can increase vulnerability to natural disasters. Antimodern communities avoided disaster in this case by stepping off the treadmill of production and practicing technological triage. The challenge for modern communities is to make an ecologically reflexive triage.

In response to a critical need for uniform school crisis preparedness and response efforts across districts, the National Association of School Psychologists developed PREPaRE, a model and training curriculum aimed to equip school-based professionals to engage in comprehensive school crisis prevention and intervention practices. The PREPaRE acronym stands for: Prevent/Prepare for psychological trauma; Reaffirm physical health, security, and safety; Evaluate psychological trauma; Provide interventions (and) Respond to psychological needs; and Examine the effectiveness of prevention and intervention efforts. The model spans four crisis preparedness phases: Prevention, Mitigation, Response, and Recovery. This chapter provides a detailed overview of the development and structure of the PREPaRE model's core components and the organizational framework of the Incident Command System. It delineates elements of the basic school crisis response plan, assessment of mental health risk following a crisis event, and the provision of crisis interventions within a multitiered system of support framework. Additionally, it summarizes ongoing effectiveness and implementation research used to evaluate and improve the model based on immediate training outcomes assessed through pre and postmeasures and training transfer to applied school contexts. Implications for research and public policy regarding school safety and crisis prevention and intervention, as well as the future of PREPaRE curriculum development, are discussed.

As a key component of the American health care system, the physician office could be the front line in a bioterrorist attack. Nationally and locally, the primary focus on this subject appears to be from a hospital preparedness and public health agency perspective, with little attention devoted to primary physician providers in their own offices, and those specialists to whom patients may be referred. While unrelated to bioterrorism, the recent SARS outbreak also brings to the forefront the need for physicians offices to be able to clinically, operationally, and managerially respond to illnesses that mirror the symptoms of known illnesses, but may be more virulent new organisms or hybrids of existing organisms. If the face of bioterrorism is subtle and slow in its presentation, physicians, in their own offices, could be the first providers of care. Will they be prepared, or will they be among the first fatalities in a bioterrorist attack?

The authors contribute to scholarly understanding of the interplay between macro-level institutions and micro-level action by focusing attention on the ways the power of institutions works through mundane organizational spaces to constrain individuals as they interact with organizations. The authors explore these macro- and micro-connections between institutions and organizational spaces through a qualitative inductive study of an emergency department in a public hospital in Australia. Analyzing observational and interview data related to a waiting room and a corridor, their findings show how the systemic power of the state and the medical profession impacts micro-level action through organizational spaces. The authors find that the medical profession exerted power in a system of domination over marginalized patients through the waiting room as an exclusion space. At the same time, the state exerted discipline power over professional subjects through the corridor as a surveillance space. Individual resistance to institutional power over the ED was controlled by policing deviance in the surveillance space and ejecting resisters to the exclusion space. Their findings contribute to the literature by opening up new insight into how mundane organizational spaces convey institutional power by dominating and disciplining micro-level actions.

The Lemuel Shattuck Hospital Youth Service Program adopted a public health approach to address the mental health needs of incarcerated juvenile offenders in Massachusetts. The program, which operated for 6 years, provided psychiatric care and neuropsychological assessment to delinquent youth as well as training for psychiatry residents, neuropsychology fellows and Massachusetts Department of Youth Services’ staff. The program recognized and attempted to address the health care disparity of limited access to quality mental health services for incarcerated youth, particularly those from disadvantaged and minority backgrounds. The program was a collaborative venture among the Massachusetts Departments of Public Health and Youth Services, and Tufts-New England Medical Center. The scope of the problem of mental health care for incarcerated youth will be first outlined, followed by a history and evaluation of the program from a public health and system integration perspective.

This work investigates a regional hospital, which has an affiliated low-acuity emergency department (ED) facility that currently struggles to meet its service level goal (85% of its patients should be in the room in 60 minutes or less). A capability analysis using data from existing processes at this facility revealed that with the current processes and current level of resources, the facility is not capable of meeting existing service level goal. A simulation was developed to examine multiple alternatives that could improve patient flow at the facility. A set of scenarios were created that modified one or more of the resources such as doctors, nurses, and rooms by changing their schedules or their quantities. The impact of the response variables related to the facility’s service level goal was recorded for each scenario. Based on the results of the simulation, recommendations to the facility for alternative ways to schedule and allocate its resources in order to meet its current service level goal were given.