Optimizing Global Resiliency in Public Health, Emergency Response, and Disaster Medicine

Abstract

Resiliency through use of point-of-care (POC) testing in small-world networks will change the future landscape by bringing evidence-based decision-making to sites of need globally. This issue of Point of Care addresses fundamental principles and essential building blocks that mitigate crises and enhance standards of care. Several papers on needs assessment support the case for onsite testing in different medical situations. Then, the focus shifts to how to protect POC devices and reagents from extremes of temperature and humidity that are encountered virtually anywhere POC testing is used outside hospitals. Indeed, the effects of environmental stresses can no longer be ignored. We have observed the advent of the “hybrid laboratory” where POC whole-blood analysis is performed using transportable instruments in non-laboratory settings and the rapid expansion of portable and handheld testing now found ubiquitously worldwide. Emerging new POC technologies will propel personalized medicine by targeting treatment. Trendy as these advances are, in low-resource settings POC instruments often represent the default armamentarium of the small community hospital. Hence, education and competency become essential prerequisites for creating, maintaining, harmonizing, and standardizing accuracy and quality as new cost-effective technologies become available. Excellent performance brings value, which is one of the keys to this next phase in the history of point of care. By increasing the value of decision-making at the site of care, we can assure resiliency, for the individual patient who might be in need of self-monitoring, for rational responses to crises, and for nations made up of more resilient individual communities.

Resilient means the ability to recover readily. Psychologically, resiliency in an individual suggests coping with stress and adversity, then bouncing back to normalcy, perhaps in even better shape than before. “That which does not kill us makes us stronger!”—Nietzsche. Resiliency to life-threatening events is not uncommon. This idea, with a caveat, is backed by scientific evidence, as Seery et al.¹ reported: “In a multiyear longitudinal study of a national sample, people with a history of some lifetime adversity reported better mental health and well-being outcomes than not only people with a high history of adversity but also than people with no history of adversity …. people with some prior lifetime adversity were the least affected by recent adverse events. These results suggest that, in moderation, whatever does not kill us may indeed make us stronger.”

Here, the key is moderation, and in fact, it is the moderation of adverse effects of crises where point-of-care (POC) testing can contribute significantly, not only to individual well-being and medical outcomes, but also to process enhancement. Characteristics of resilient processes include planning, resourcefulness, protection, coordination, continuity, networking, risk reduction, access to adequate resources, and effective communications, along with training and education of doctors, nurses, technicians, medical staff, and responders. “To build collective resilience, communities must reduce risk and resource inequities, engage local people in mitigation, create organizational linkages, boost and protect social supports, and plan for not having a plan, which requires flexibility, decision-making skills, and trusted sources of information that function in the face of unknowns.”² Point of care provides impactful information that reduces the unknowns. Reducing unknowns mitigates risk.

Albanese et al.³ devised a framework for safe and resilient hospitals within integrated community disaster responses. Bosher and Dainty⁴ proposed risk reduction through a parallel scheme for literally building in resilience in the constructed environment. Geelen-Baass and Johnstone⁵ make the case for business continuity management, Sheth et al.⁶ provide a practical dashboard for measuring capability, and Hill et al.⁷ suggest ameliorating adversity through alternative resiliency investments, which should not exclude new POC approaches and technologies, especially in view of the favorable precedent set by POC instruments introduced broadly during Hurricane Katrina.^8,9 Following Katrina, Kost coined the term, “newdemics,”¹⁰ for modern crises, since the unexpected can wreak havoc rapidly in demographically saturated regions, and with international colleagues, innovated POC testing embedded in small-world networks^11–17 for resiliency, preparedness, and enhanced crisis standards of care.¹⁸ Extreme weather events and other emerging exigencies motivate us all to build human resilience.¹⁹

Multivariate analyses indicate that the prevalence of resilience is uniquely predicted by gender, age, race/ethnicity, education, level of trauma exposure, income change, social support, frequency of chronic disease, and recent and past life stressors.²⁰ Pre-existing relationships that ease communication challenges, continuation of organizational patterns of response integration, and known role assignments contribute to resilience.²¹ Hence, the emergency management and homeland security sectors must collaborate to engage the community better.^22,23 Therefore, in support of human resilience, it is logical to assemble the building blocks of process, per se, using a heretofore somewhat neglected element, namely, adaptive and connected POC testing in small-world networks where it is needed the most by people who use it every day, but then can also respond more effectively to complex emergencies, disasters, and public health crises in small community hospitals, in alternate care facilities, or directly at points of need.

We can meet these complex challenges by devising and implementing new needs-based POC approaches, by positioning them in evidence-based care paths for rapid decision-making, and by assuring continuity in diagnosis, triage, monitoring, and therapy within communities. The authors in this issue of Point of Care provide the necessary framework for simultaneous point-of-care integration, synthesis by care teams at the point of need, and optimization of practical strategies directly within those communities. Then, the resilient communities will create resilient nations, the ultimate goal.