How can we use wastewater, sunshine, and psychological first aid to improve emergency preparedness and response? These are some of the questions that we have been exploring in our research, and that we discussed in our annual meeting last week. 

Our team, including members of our Independent Advisory Group, met at the home of the Royal College of General Practitioners in Euston, London. The EPR HPRU in its current form is entering the last year of its five-year plan, and in our annual meeting we reflected on what we have learned and how we can put this into action now and in the future. 

Here are some of the research highlights from the last year, and our plans for each theme, where as a Unit, we will focus on knowledge mobilisation and dissemination: 

Preparedness theme 

Some of our research highlights in the past year include: 

• Development and evaluation of a training programme for first responders, which aimed to increase their knowledge and confidence in joint working with other agencies and sectors. 

• Development and evaluation of tools for first responders, including a major incident triage tool, and a submerged person survivability tool. 

• Research showed that ‘vulnerability registers’, such as the priority services register or clinically extremely vulnerable register, do not work well and can’t be the foundation of health equity and public health strategies. The same research also found that using the term ‘vulnerable’ can be counterproductive and should be avoided in communications generally. Language that clearly describes who you are speaking about is more appropriate (e.g. “people aged 75 and over” or “people receiving chemotherapy”).

• A review asked how English schools teach students to be ready for disasters. It found that the teaching materials are not well evidenced or tested. The study also found that the materials were not usually co-designed with schools, did not consider the local risks, and did not always match the government’s advice. 

We have a busy year ahead, including working with the Cabinet Office to undertake a survey of public attitudes, perceptions and behaviours related to risk, resilience and preparedness in the UK. This will help to inform the information and advice that is provided to people about how to prepare for and cope with different types of emergencies and disasters. We are also developing and evaluating pre-incident information using novel Immersive Virtual Environment Technology (IVET) to develop realistic mass casualty scenarios within which public behaviour can be examined. We are also looking forward to the start of a new project exploring the available evidence for the impact of tailored public health communication strategies in deprived and ethnic minority populations during infectious disease incidents in the UK. 

Finally, we have several ongoing PhD projects, which will inform the development of education for effective preparedness for extreme events for audiences such as the general public, schools, and those who may need extra help during emergencies. 

Resilience theme 

Some of our research highlights in the past year include: 

• Reviews on the impact of COVID-19 on the mental health and wellbeing of sex workers and pet owners. 

• Understanding the impact of living in damp and mouldy homes on people’s mental and physical health. 

• A review of the role of community resilience and social capital in coping with disasters. 

• Development of a Psychological First Aid course to help the general public support individuals who have experienced stressful or traumatic events. 

Two PhD projects are progressing well, the findings of which will be used to made recommendations on: 1) how to support people with long COVID and other chronic conditions, and; 2) how to improve wellbeing in UK Government employees who are asked to work from home during the response to a major incident. 

In the next year we are focusing on impact, including a randomised controlled trial (RCT) to evaluate the effectiveness of an intervention to improve the mental health of workers after a traumatic event by training their managers to recognise and support their needs. We are also planning an RCT to evaluate the impact of our psychological first aid e-learning platform. Lastly, we are going to focus on how to mobilise the wealth of research and evidence that we have generated across the HPRU to provide clear and succinct advice to policy makers and practitioners concerning resilience during and after public health emergencies.  

Response 

Some of our research highlights in the past year include: 

• Investigations into the 2022 mpox (monkeypox) outbreak, including what people knew, thought, and how they acted, and how different messages influenced people’s actions.  

• Teenagers have a right to be heard, especially on public health-related policies that directly affect them. We partnered with a local school to build an ongoing reciprocal programme where pupils were given work experience and masterclasses (and free breakfast!) in exchange for co-designing a study on adolescent attitudes to vaccines. 

• Understanding what affected whether people were able to self-isolate during the COVID-19 pandemic, and how self-isolation affected people’s wellbeing. 

Next year we are planning research that will address some of the challenges of conducting surveys rapidly in response to different incidents. We will identify behaviours that people may be asked to carry out in different emergencies, and attitudes and beliefs that are often linked with behaviour, with the aim of developing ‘off the shelf’ surveys that can be used in a range of emergencies. We are also consulting with people who work with poultry during an avian influenza outbreak, to co-produce public health information about steps they can take to protect themselves from catching and spreading the virus. 

Finally, two PhD projects are ongoing, exploring how governmental organisations can improve their trustworthiness amongst minority groups during outbreaks of illnesses and understanding what is important to teenagers when they are considering whether to have a vaccine.  

Novel Technologies 

Some of our research highlights in the past year include: 

• Analysis of the wastewater concentrations of COVID-19 RNA, and whether they can be used to predict the number of cases of COVID-19 across the UK. 

• Comparison of the usefulness of different indicators of COVID-19 infection, such as the ONS National Infection survey, Zoe app, calls to NHS 111, and emergency department attendances. We investigated how they can be used to complement each other and provide a more accurate picture of infectious disease outbreaks. 

• Understanding how incident directors use data and information for managing mass gatherings and incidents. 

A PhD project is making good progress, investigating how presentations to different healthcare settings changed during extreme events, using real-time syndromic surveillance systems and electronic healthcare records. 

We have several targets for the next year, including investigating the impact of temperature, rainfall and sunshine on the numbers contacting the mental health services monitored using real-time surveillance data. We will also explore early alerting of STEC infections. These are a type of bacteria that can cause severe diarrhoea and kidney failure, and the aim of our work is to identify increases in infections as early as possible. We are also examining the lessons learned from two decades of syndromic surveillance in England, to emphasise the consequences and opportunities for the UK and other countries as this method of public health monitoring expands.  

Artificial Intelligence and Research 

We had an inspiring presentation from the excellent Abigail Emery encouraging us to consider AI in our research when it requires divergent thinking, exploring ideas and creative solutions, and saving time. We have already put this to practice in writing this blog, and in a recent twitter post.  

We hope you enjoyed reading this blog post and learned something new about our research and activities. If you want to know more about us, you can visit our website or follow us on Twitter.