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I looked more into the U.S. policy on uninsured patients, ER hospital policy, and how they are treated. If you go the ER without insurance, you are expected to pay the full bill; however you are guaranteed under the federal Emergency Medical Treatment and Labor Act to receive treatment regardless of your ability to pay it. There are assistance programs available to help those whom cannot afford to pay their medical bills. Some of these are private charities, there are government programs that help with those at or below the poverty line, and the hospitals themselves will often negotiate a much lower price than originally billed for to meet a patient’s financial need. Despite this, there are still many cases where all of the above are not sufficient enough to keep patients out of bankruptcy. (http://health.howstuffworks.com/medicine/go-to-er-without-insurance.htm)

The extensive citation show the work that went into the research to put the article together. The article cites other research articles as well as government publications and interviews.

Dr. Emily Goldmann graduated from the University of Michigan with her PhD in Epidemiology and Columbia University with a Bachelor’s in economics and Chinese. Dr. Goldmann is currently a clinical assistant Professor of Global Public Health at New York University. “I am currently on the faculty of NYU's College of Global Public Health, in the Division of Social Epidemiology. My current research focuses on the intersection between physical and mental health in older adults, specifically trajectories of depressive symptoms following stroke. I also have a strong interest in the characterization, prevention, and treatment of mental illness in low-resource settings globally. I currently teach a master's level course in global mental health and an introductory course in epidemiology to undergraduate students.” (LinkedIn profile)

Dr. Sandro Galea graduated from University of Toronto with his MD, Harvard with a MPH, and Columbia with a DPH. Dr. Galea works as a physician and epidemiologist at Boston University School of Public Health. “In his scholarship, Dr Galea is centrally interested in the social production of health of urban populations, with a focus on the causes of brain disorders, particularly common mood-anxiety disorders and substance abuse. He has long had a particular interest in the consequences of mass trauma and conflict worldwide, including as a result of the September 11 attacks, Hurricane Katrina, conflicts in sub-Saharan Africa, and the American wars in Iraq and Afghanistan. ” (Boston University Biography)

The bibliography is not included in the excerpt that we received. Based on the text it appears that many other research articles and outside studies were used as well as interviews.

The author uses a wide variety of news and journal sources to make their point. Everything from the New York Times to East Asian Science. It also cites many volumes on disaster preparedness. For example, “The Chernobyl Accident: a Case Study in International Law Regulation State Responsibility for Transboundary”. The sources tell me that the article was developed around the news at the time and works that dealt with handling of disasters from the past. For me, this furthers the case that the author is making: that the way we have been doing things in the past is not working.

I looked into how EMS operates in situations that are beyond protocols, standing orders, and medical control. I also looked into how story cases are used by other medical professionals. Further I looked into how “evidence” based approaches are formulated for studies and research.

1) “When tuberculosis treatment fails. A social behavioral account of patient adherence.” By Sumartojo E. Describes the demographic and cultural factors in monitoring and improving adherence to TB regiments.

2) “Racial differences in the use of drug therapy for HIV disease in an urban community.” By Moore RD, Stanton D, Gopalan R, Chaisson RE. Blacks were found to be less likely to receive therapy than whites even when gender, social status, age, and place of residence had no effect on variation in treatment. In emergency response, a similar issue is possible.

3) “Women's voices rise as Rwanda reinvents itself” by Lacey M. This article helps in understanding the long term effects emergencies leave on a country, namely the Rwanda Genocide of 1994. 

This policy applies to all persons residing (regardless of legal status) in the U.S. and any of its territories as well as the District of Columbia who require medical screening examinations as outlined in the act or treatment for an emergency medical condition. 

1) Culling animals to control disease outbreak. World Organization for Animal Health (OIE) (http://www.oie.int/doc/ged/D2704.PDF)

2) Main bio-threats to US national security. Department of Homeland Security (DHS): (https://www.dhs.gov/xlibrary/assets/prep_biological_fact_sheet.pdf)

3) Main bio-threats to developing countries. The National Academies Press: (https://www.nap.edu/read/12596/chapter/5#48)

 “From the first moments to the last, however, their efforts were plagued by failures of communication, command and control.” This main point is supported in several ways. The police helicopters said that the collapse of the towers was “imminent” a full 20 minutes before the south tower fell and an hour and 29 minutes before the north tower. Most firefighters in the north tower did not even know that the south tower had fallen. Most fighter fighters did not recall ever hearing the dispatch to evacuate the north tower despite multiple broadcasts. The chain of command and orderly response also failed. First responders ignored and disobeyed orders to wait to respond until called upon. Some self-dispatched taking taxis, driving themselves, and hoping on other departments’ rigs. “Discipline Broke Down In Eagerness to Help”. The police commissioner, Bernard B. Kerik, did not even know that there were any serious communication issues between the agencies. Assistant Chief Joseph Callan ordered an evacuation of the north tower at 9:32 am, almost a full hour before it fell, but few ever received this command. These failures resulted in the needless loss of life and a response that could have been far better.