Showing papers in "Disaster Medicine and Public Health Preparedness in 2016"
TL;DR: A systematic review of evaluation tools for hospital disaster preparedness found none of the evaluated checklists and tools included all dimensions required for an appropriate hospital preparedness evaluation.
Abstract: Hospitals need to be fully operative during disasters. It is therefore essential to be able to evaluate hospital preparedness. However, there is no consensus of a standardized, comprehensive and reliable tool with which to measure hospital preparedness. The aim of the current study was to perform a systematic review of evaluation tools for hospital disaster preparedness. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words "crisis," "disaster," "disaster medicine," "emergency," "mass casualty," "hospital preparedness," "hospital readiness," "hospital assessment," "hospital evaluation," "hospital appraisal," "planning," "checklist," and "medical facility" were used in combination with the Boolean operators "OR" and "AND." PubMed (National Library of Medicine, Bethesda, MD), ISI Web of Science (Thomson Reuters, New York, NY), and Scopus (Elsevier, New York, NY) were searched. A total of 51,809 publications were screened. The following themes were required for relevance: logistics, planning, human resources, triage, communication, command and control, structural and nonstructural preparedness, training, evacuation, recovery after disaster, coordination, transportation, surge capacity, and safety. The results from 15 publications are presented. Fifteen articles fulfilled the criteria of relevance and considered at least 1 of the 14 predetermined themes. None of the evaluated checklists and tools included all dimensions required for an appropriate hospital preparedness evaluation. The results of the current systematic review could be used as a basis for designing an evaluation tool for hospital disaster preparedness. (Disaster Med Public Health Preparedness. 2016;page 1 of 8).
61 citations
TL;DR: The rescue and treatment of pediatric patients by the Chinese Red Cross medical team during the Nepal earthquake relief should consider the necessity of treating non–disaster-related conditions, when developing a rescue plan and arranging medical resources.
Abstract: OBJECTIVE: To retrospectively analyze the rescue and treatment of pediatric patients by the Chinese Red Cross medical team during the Nepal earthquake relief. METHODS: The medical team set up a field hospital; the pediatric clinic consisted of 1 pediatrician and several nurses. Children younger than 18 years old were placed in the pediatric clinic for injury examination and treatment. RESULTS: During the 7-day period of medical assistance (the second to third week after the earthquake), a total of 108 pediatric patients were diagnosed and treated, accounting for 2.8% of the total patients. The earthquake-related injuries mainly required surgical dressing and debridement. No severe limb fractures or traumatic brain injuries were found. Infection of the respiratory tract, the gastrointestinal tract, and the skin were the most common ailments, accounting for 42.3%, 18.5%, and 16.7%, respectively, of the total treated patients. CONCLUSION: Two to 3 weeks after the earthquake, the admitted pediatric patients mainly displayed respiratory and gastrointestinal infections. When developing a rescue plan and arranging medical resources, we should consider the necessity of treating non-disaster-related conditions. (Disaster Med Public Health Preparedness. 2016;page 1 of 4). Language: en
45 citations
TL;DR: This program enables interagency cooperation and collaboration and could be used to increase and improve decision-makers’ understanding of disaster managers’ capabilities; at the strategic/tactical level to promote the knowledge and capability of the disaster managers themselves; and as continuing education or further career development for disaster managers at the operational level.
Abstract: OBJECTIVE: Although there is a significant willingness to respond to disasters, a review of post-event reports following incidents shows troubling repeated patterns with poorly integrated response activities and response managers inadequately trained for the requirements of disasters. This calls for a new overall approach in disaster management. METHODS: An in-depth review of the education and training opportunities available to responders and disaster managers has been undertaken, as well as an extensive review of the educational competencies and their parent domains identified by subject matter experts as necessary for competent performance. RESULTS: Seven domains of competency and competencies that should be mastered by disaster mangers were identified. This set of domains and individual competencies was utilized to define a new and evolving curriculum. In order to evaluate and assess the mastery of each competency, objectives were more widely defined as activities under specific topics, as the measurable elements of the curriculum, for each managerial level. CONCLUSIONS: This program enables interagency cooperation and collaboration and could be used to increase and improve decision-makers' understanding of disaster managers' capabilities; at the strategic/tactical level to promote the knowledge and capability of the disaster managers themselves; and as continuing education or further career development for disaster managers at the operational level. (Disaster Med Public Health Preparedness. 2016;page 1 of 20). Language: en
42 citations
TL;DR: Patients who were elderly or homeless or who had diabetes, dementia, cardiac conditions, limitations in mobility, or drug dependence were more likely to visit emergency departments after Hurricane Sandy, and patients wereMore likely to develop drug-resistant infections, require isolation, and present for hypothermia, environmental exposures, or administrative reasons.
Abstract: OBJECTIVE: We aimed to characterize the geographic distribution of post-Hurricane Sandy emergency department use in administrative flood evacuation zones of New York City. METHODS: Using emergency claims data, we identified significant deviations in emergency department use after Hurricane Sandy. Using time-series analysis, we analyzed the frequency of visits for specific conditions and comorbidities to identify medically vulnerable populations who developed acute postdisaster medical needs. RESULTS: We found statistically significant decreases in overall post-Sandy emergency department use in New York City but increased utilization in the most vulnerable evacuation zone. In addition to dialysis- and ventilator-dependent patients, we identified that patients who were elderly or homeless or who had diabetes, dementia, cardiac conditions, limitations in mobility, or drug dependence were more likely to visit emergency departments after Hurricane Sandy. Furthermore, patients were more likely to develop drug-resistant infections, require isolation, and present for hypothermia, environmental exposures, or administrative reasons. CONCLUSIONS: Our study identified high-risk populations who developed acute medical and social needs in specific geographic areas after Hurricane Sandy. Our findings can inform coherent and targeted responses to disasters. Early identification of medically vulnerable populations can help to map "hot spots" requiring additional medical and social attention and prioritize resources for areas most impacted by disasters. (Disaster Med Public Health Preparedness. 2016;page 1 of 11). Language: en
40 citations
TL;DR: The results affirm the feasibility of engaging laypeople as immediate lifesavers of trauma victims and justify further efforts to boost rates of proper application of tourniquet application.
Abstract: Objective To determine whether a color-coded tourniquet designed for public use increases successful tourniquet application by laypeople. Methods This was a randomized study conducted on April 25, 2015. The study occurred during the Maryland Day activity at the University of Maryland in College Park, Maryland. Investigators recruited participants with posters displayed at major crosswalks around a central testing area. A total of 157 volunteers aged 18 years or older and without prior military service or medical training were enrolled. A participant stood in front of a waist-down mannequin with an isolated leg injury while an investigator read aloud a mass causality scenario. The investigator then asked the participant to apply a tourniquet to the mannequin’s leg. All participants received a 4-step illustrated just-in-time (JiT) instruction card designed to facilitate layperson tourniquet application. Test participants received a color-coded tourniquet designed for layperson use with instructions printed on the device. Control participants received a black Combat Application Tourniquet (C-A-T; Composite Resources, Rock Hill, SC). Participants were randomized in a 1:1 ratio in blocks of 50. The primary outcome was the proportion of successful tourniquet applications by those who received color-coded tourniquets compared to those who received black tourniquets. Secondary outcomes included validation of previous data analyzing layperson success with tourniquet application, time for successful placement, reasons for failed applications, and participant self-willingness and comfort using tourniquets. We also analyzed demographic data on the study population and inter-rater reliability regarding the assessment of successful tourniquet application. Results Participants supplied with color-coded tourniquets successfully placed the device 51.38% of the time, compared to 44.71% of the time for controls using a black tourniquet (risk ratio: 1.15; 95% confidence interval: 0.83-1.59; P=0.404). Participants’ self-reported willingness to use a tourniquet rose from 40.8% before the study to 80.3% after the study (P<0.05). Conclusions The color-coded device did not significantly increase laypeople’s proportion of successful tourniquet applications when compared with a standard black device. However, this study reproduced pilot study data showing that laypeople can successfully apply tourniquets about half the time if provided JiT instructions. Age, sex, race, income, and highest level of education were not found to impact one’s ability to properly apply a tourniquet. Laypeople’s willingness to apply tourniquets doubled to 80% after brief exposure to the device. These results affirm the feasibility of engaging laypeople as immediate lifesavers of trauma victims and justify further efforts to boost rates of proper application. (Disaster Med Public Health Preparedness. 2016;10:274–280)
38 citations
TL;DR: It is suggested that the critical temporal window during which ED resources should be increased is in the immediate aftermath of a hurricane.
Abstract: OBJECTIVE: This study aimed to examine the effect of Hurricane Sandy on Long Island mental health emergency department (ED) visits and to determine whether these visits varied according to patient demographics or geographic area and intensity of the impact. METHODS: Individual-level de-identified data were extracted from the Statewide Planning and Research Cooperative System from New York State ED visits from October 1 to December 2012 for residents of Nassau and Suffolk counties in Long Island. The dates of the ED visits were grouped into 4 periods: (1) pre-Sandy, October 1-28; (2) during Sandy, October 29; (3) post-Sandy I, October 30 to November 1; and (4) post-Sandy II, November 2-30. RESULTS: A total of 126,337 ED visits were recorded among 23 EDs. A significant drop in volume was observed on October 29; 399 more ED visits for physical health diagnoses were identified in the post-Sandy I period than in the pre-Sandy period. "Diseases of the respiratory system" was the only diagnosis group that showed a positive trend in the post-Sandy I period compared with the pre-Sandy period (increase of 4%). No significant changes in mental health visits were observed after Sandy landfall. CONCLUSIONS: This analysis suggests that the critical temporal window during which ED resources should be increased is in the immediate aftermath of a hurricane. (Disaster Med Public Health Preparedness. 2016;page 1 of 7). Language: en
30 citations
TL;DR: Perceived stress was high in areas affected by Hurricane Sandy and was significantly associated with individual hurricane exposure and was a first step toward defining what segments of the population are more vulnerable and informing intervention and emergency preparedness efforts.
Abstract: OBJECTIVE: Hurricane Sandy was one of the deadliest storms in US history, with at least 162 deaths and numerous injuries. This research aimed to quantify the impact of Hurricane Sandy on the New York metropolitan area. METHODS: The project included 601 volunteers aged at least 18 years who were recruited in Nassau, Suffolk, Queens, and Richmond counties and Staten Island between 2013 and 2014 through close partnerships with coalition community leaders. Participants completed a self-administered questionnaire on demographics and behavioral factors and a 35-point check off list on hurricane exposure. Perceived stress was assessed by using the 10-item Perceived Stress Scale (PSS). RESULTS: Participants had a mean stress score of 15.6 (SD=7.3; vs general population mean of 13.0), with 30.14% of the sample categorized as "high stress" (mean≥20). In the multivariable regression analysis, age was significantly negatively associated with PSS score. A reported history of mental health issues, Hispanic ethnicity, and overall exposure to Hurricane Sandy were statistically significantly associated with PSS score in a positive direction. CONCLUSIONS: Perceived stress was high in areas affected by Hurricane Sandy and was significantly associated with individual hurricane exposure. This study is a first step toward defining what segments of the population are more vulnerable and informing intervention and emergency preparedness efforts. (Disaster Med Public Health Preparedness. 2015;0:1-8). Language: en
30 citations
TL;DR: The findings indicated that because vulnerable adults can be identified before disaster strikes, the opportunity to mitigate disaster-related PTSD exists through identification and resource programs that target population subgroups.
Abstract: OBJECTIVE: Drawing on pre-disaster, peri-disaster, and post-disaster data, this study examined factors associated with the development of post-traumatic stress disorder (PTSD) symptoms in older adults exposed to Hurricane Sandy. METHODS: We used a sample of older participants matched by gender, exposure, and geographic region (N=88, mean age=59.83 years) in which one group reported clinically significant levels of PTSD symptoms and the other did not. We conducted t-tests, chi-square tests, and exact logistic regressions to examine differences in pre-disaster characteristics and peri-disaster experiences. RESULTS: Older adults who experienced PTSD symptoms reported lower levels of income, positive affect, subjective health, and social support and were less likely to be working 4 to 6 years before Hurricane Sandy than were people not experiencing PTSD symptoms. Those developing PTSD symptoms reported more depressive symptoms, negative affect, functional disability, chronic health conditions, and pain before Sandy and greater distress and feelings of danger during Hurricane Sandy. Exact logistic regression revealed independent effects of preexisting chronic health conditions and feelings of distress during Hurricane Sandy in predicting PTSD group status. CONCLUSIONS: Our findings indicated that because vulnerable adults can be identified before disaster strikes, the opportunity to mitigate disaster-related PTSD exists through identification and resource programs that target population subgroups. (Disaster Med Public Health Preparedness. 2016;page 1 of 9). Language: en
28 citations
TL;DR: The New York City Department of Health and Mental Hygiene has successfully used its Social Media Monitoring Team during public health emergency responses and planned events including major Ebola and Legionnaires’ disease responses.
Abstract: Social media monitoring for public health emergency response and recovery is an essential response capability for any health department. The value of social media for emergency response lies not only in the capacity to rapidly communicate official and critical incident information, but as a rich source of incoming data that can be gathered to inform leadership decision-making. Social media monitoring is a function that can be formally integrated into the Incident Command System of any response agency. The approach to planning and required resources, such as staffing, logistics, and technology, is flexible and adaptable based on the needs of the agency and size and scope of the emergency. The New York City Department of Health and Mental Hygiene has successfully used its Social Media Monitoring Team during public health emergency responses and planned events including major Ebola and Legionnaires' disease responses. The concepts and implementations described can be applied by any agency, large or small, interested in building a social media monitoring capacity. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).
27 citations
TL;DR: Experience with the 2010 Haiti earthquake was associated with worse reproductive and birth outcomes, which underscores the need to provide reproductive health services as part of relief efforts.
Abstract: Objective We aimed to examine the relationship between exposure to the 2010 Haiti earthquake and pregnancy wantedness, interpregnancy interval, and birth weight. Methods From the nationally representative Haiti 2012 Demographic and Health Survey, information on “size of child at birth” (too small or not) was available for 7280 singleton births in the previous 5 years, whereas information on birth weight was available for 1607 births. Pregnancy wantedness, short (<1 year) interpregnancy interval, and maternal-reported birth weight were compared before and after the earthquake and by level of damage. Multiple logistic regression and linear regression analyses were conducted. Results Post-earthquake births were less likely to be wanted and more likely to be born after a short interpregnancy interval. Earthquake exposure was associated with increased likelihood of a child being born too small: timing of birth (after earthquake vs. before earthquake, adjusted odds ratio [aOR]: 1.27, 95% confidence interval [CI]: 1.12-1.45), region (hardest-hit vs. rest of country; aOR: 1.43, 95% CI: 1.14- 1.80), and house damage (aOR: 1.27 95% CI: 1.02-1.58). Mean birth weight was 150 to 300 g lower in those exposed to the earthquake. Conclusions Experience with the earthquake was associated with worse reproductive and birth outcomes, which underscores the need to provide reproductive health services as part of relief efforts. (Disaster Med Public Health Preparedness. 2016;10:59-66)
27 citations
TL;DR: ICU providers who evacuated critically ill patients during Hurricane Sandy had little prior knowledge of evacuation processes or vertical evacuation experience, and the weakest links in the patient evacuation process were communication and the availability of practical tools.
Abstract: OBJECTIVE: Data on best practices for evacuating an intensive care unit (ICU) during a disaster are limited. The impact of Hurricane Sandy on New York City area hospitals provided a unique opportunity to learn from the experience of ICU providers about their preparedness, perspective, roles, and activities. METHODS: We conducted a cross-sectional survey of nurses, respiratory therapists, and physicians who played direct roles during the Hurricane Sandy ICU evacuations. RESULTS: Sixty-eight health care professionals from 4 evacuating hospitals completed surveys (35% ICU nurses, 21% respiratory therapists, 25% physicians-in-training, and 13% attending physicians). Only 21% had participated in an ICU evacuation drill in the past 2 years and 28% had prior training or real-life experience. Processes were inconsistent for patient prioritization, tracking, transport medications, and transport care. Respondents identified communication (43%) as the key barrier to effective evacuation. The equipment considered most helpful included flashlights (24%), transport sleds (21%), and oxygen tanks and respiratory therapy supplies (19%). An evacuation wish list included walkie-talkies/phones (26%), lighting/electricity (18%), flashlights (10%), and portable ventilators and suction (16%). CONCLUSIONS: ICU providers who evacuated critically ill patients during Hurricane Sandy had little prior knowledge of evacuation processes or vertical evacuation experience. The weakest links in the patient evacuation process were communication and the availability of practical tools. Incorporating ICU providers into hospital evacuation planning and training, developing standard evacuation communication processes and tools, and collecting a uniform dataset among all evacuating hospitals could better inform critical care evacuation in the future. (Disaster Med Public Health Preparedness. 2015;0:1-8). Language: en
TL;DR: In this paper, the authors describe disaster preparedness strategies and behaviors among rural families who have children with special health care needs and examine the effect of selfefficacy and response-efficacy on disaster preparation.
Abstract: OBJECTIVE: The purpose of this study was to describe disaster preparedness strategies and behaviors among rural families who have children with special health care needs and to examine the effect of self-efficacy and response-efficacy on disaster preparedness. METHODS: Data for this study were drawn from the baseline surveys of 287 rural families with children with special health care needs who were part of a randomized controlled trial examining the impact of an intervention on disaster preparedness. Distributions of child, parent, and family characteristics were examined by preparedness. Linear regression models were built to examine the impact of self-efficacy and response-efficacy on level of disaster preparedness. RESULTS: Disaster preparedness (overall, emergency plan, discussion/practice, and supplies) was low (40.9-69.7%) among study families. Disaster preparedness was found to increase with each unit increase in the level of self-efficacy and family resilience sources across all 4 categories of preparedness. CONCLUSIONS: Disaster preparedness among rural families with children with special health care needs is low, which is concerning because these children may have increased vulnerability to adverse outcomes compared to the general population. RESULTS suggest that increasing the levels of self-efficacy and family resilience sources may increase disaster preparedness. (Disaster Med Public Health Preparedness. 2016;0:1-8). Language: en
TL;DR: Investigation of the prevalence of psychological symptoms among 993 residents of Taean District in South Korea after the Hebei Spirit oil spill found risk of suicidal ideation was predominantly increased in people with fishery or related occupations compared with those with unrelated livelihoods and people residing in the vicinity of the oil band in the contaminated coastline showed additively increased symptom risks.
Abstract: Objective Psychological health is an important issue after disasters. This study aimed to investigate the prevalence of psychological symptoms among 993 residents of Taean District in South Korea after the Hebei Spirit oil spill and to examine determinants of vulnerability in residents’ psychological symptoms. Methods Symptoms of post-traumatic stress (PTS), depression, suicidal ideation, and anxiety were assessed by questionnaires, and the responses were analyzed by using the survey analysis considering the sampling frame. Results Among the study subjects, the symptom prevalences of PTS, depression, suicidal ideation, and anxiety were 19.5%, 22.0%, 2.3%, and 4.2%, respectively, and symptoms were higher in people who were female, were older, were less educated, and had lower family income. People with fishery or related occupations compared to those with unrelated livelihoods and people residing in the vicinity of the oil band in the contaminated coastline showed additively increased symptom risks of PTS. Risk of suicidal ideation was predominantly increased in people with fishery or related occupations compared with those with unrelated livelihoods. Conclusions Social supports, including compensation for income loss and community mental health programs, and longer follow-up studies are needed for residents in the communities affected by the Hebei Spirit oil spill. (Disaster Med Public Health Preparedness. 2016;10:51-58)
TL;DR: After 4 years of civil war in Syria, children have lost parents, live in substandard life quality circumstances, and are at risk for outbreaks because of worsening vaccination states and insufficient availability of health care providers.
Abstract: Objective The Syrian civil war since 2011 has led to one of the most complex humanitarian emergencies in history. The objective of this study was to document the impact of the conflict on the familial, educational, and public health state of Syrian children. Methods A cross-sectional observational study was conducted in May 2015. Health care workers visited families with a prospectively designed data sheet in 4 Northern Syrian governorates. Results The 1001 children included in this study originated from Aleppo (41%), Idleb (36%), Hamah (15%), and Lattakia (8%). The children’s median age was 6 years (range, 0-15 years; interquartile range, 3-11 years), and 61% were boys. Almost 20% of the children were internally displaced, and 5% had deceased or missing parents. Children lacked access to safe drinking water (15%), appropriate sanitation (23%), healthy nutrition (16%), and pediatric health care providers (64%). Vaccination was inadequate in 72%. More than half of school-aged children had no access to education. Children in Idleb and Lattakia were at greater risk of having unmet public health needs. Younger children were at greater risk of having an incomplete vaccination state. Conclusions After 4 years of civil war in Syria, children have lost parents, live in substandard life quality circumstances, and are at risk for outbreaks because of worsening vaccination states and insufficient availability of health care providers. (Disaster Med Public Health Preparedness. 2016;10:874–882)
TL;DR: A critical analysis of this paradigm shift in India’s disaster management policy through the prism of 2 cyclones, 14 years apart in time aims to highlight key steps in this success and calls for futuristic approaches like insurance programs and gender-sensitive recovery plans.
Abstract: OBJECTIVE: The mainstay of India's disaster management policy until the early 2000s had been relief and rescue operations. The Odisha Super Cyclone (1999) with 10,000 deaths and US $3 billion economic damage provided a rude awakening. Recognizing the importance of preemptive preparedness, the government initiated systematic steps to implement a national framework interlinking economic, environmental, and overall developmental issues for efficient response to and mitigation of disasters. METHODS: We attempted a critical analysis of this paradigm shift in India's disaster management policy through the prism of 2 cyclones, 14 years apart in time. RESULTS: With improved preparedness and response measures, the death toll in 2013 Cyclone Phailin was 0.5% and the economic loss was about one-third of that during 1999. Concomitant improvements in the technological expertise of the early warning system, an integrated approach at all levels of administration including joint planning with major nongovernmental organizations, and improved community participation were identified as game-changers. An unbelievable 1 million people were evacuated to safety. CONCLUSIONS: Our essay aims to highlight key steps in this success and calls for futuristic approaches like insurance programs and gender-sensitive recovery plans. With thorough scrutiny, India's model may well stand to be replicated in resource-restricted settings. (Disaster Med Public Health Preparedness. 2015;0:1-5). Language: en
TL;DR: It was found that multiple co-environmental hazards occurred during Hurricane Sandy, especially power blackouts that mediated this disaster’s impacts, and the effects of power outage on mental health had large geographic variations and were substantial, especially in communities with low sociodemographic status.
Abstract: OBJECTIVES: This study describes findings of the impacts of Hurricane Sandy on environmental factors including power outages, air quality, water quality, and weather factors and how these affected mental health during the hurricane. METHODS: An ecological study was conducted at the county level to describe changes in environmental factors-especially power outages-and their relationships to emergency department (ED) visits for mental health problems by use of a Poisson regression model. RESULTS: We found that many environmental hazards occurred as co-exposures during Hurricane Sandy in addition to flooding. Mental health ED visits corresponded with the peak of maximum daily power blackouts, with a 3-day lag, and were positively associated with power blackouts in Bronx (prevalence ratio [PR]: 8.82, 95% confidence interval [CI]: 1.27-61.42) and Queens (PR: 2.47, 95% CI: 1.05-5.82) counties. A possible dose-response relationship was found between the quantile of maximum blackout percentage and the risk of mental health in the Bronx. CONCLUSION: We found that multiple co-environmental hazards occurred during Hurricane Sandy, especially power blackouts that mediated this disaster's impacts. The effects of power outage on mental health had large geographic variations and were substantial, especially in communities with low sociodemographic status. These findings may provide new insights for future disaster response and preparedness efforts. (Disaster Med Public Health Preparedness. 2016;page 1 of 6). Language: en
TL;DR: A systematic review reaffirms the effective execution of a multisectoral public health response and efficient delivery of the core functions of public health assessment, policy development, and service assurances to improve population health in the 2012–2013 multistate fungal meningitis epidemic.
Abstract: We conducted a systematic review of the 2012-2013 multistate fungal meningitis epidemic in the United States from the perspectives of clinical response, outbreak investigation, and epidemiology. Articles focused on clinical response, outbreak investigation, and epidemiology were included, whereas articles focused on compounding pharmacies, legislation and litigation, diagnostics, microbiology, and pathogenesis were excluded. We reviewed 19 articles by use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. The source of the fungal meningitis outbreak was traced to the New England Compounding Center in Massachusetts, where injectable methylprednisolone acetate products were contaminated with the predominant pathogen, Exserohilum rostratum. As of October 23, 2013, the final case count stood at 751 patients and 64 deaths, and no additional cases are anticipated. The multisectoral public health response to the fungal meningitis epidemic from the hospitals, clinics, pharmacies, and the public health system at the local, state, and federal levels led to an efficient epidemiological investigation to trace the outbreak source and rapid implementation of multiple response plans. This systematic review reaffirms the effective execution of a multisectoral public health response and efficient delivery of the core functions of public health assessment, policy development, and service assurances to improve population health.
TL;DR: A younger age, a higher concern, and lower confidence in the ability of hospitals to contain the outbreak were significantly associated with both a greater willingness to vaccinate and a larger number of protective behaviors.
Abstract: OBJECTIVE We examined public perceptions of the risk of an Ebola outbreak, knowledge about transmission, and the factors associated with planned protective behavior, including willingness to vaccinate. METHODS We conducted a cross-sectional telephone survey using random digit dialing of 750 members of the New Zealand public between February 12 and 19, 2015. RESULTS Most of the sample (72%) reported that they had been following news of the outbreak closely and 28% were concerned that there would be a large outbreak in New Zealand. High rates of planned protective behavior, in terms of avoiding contact with other people, were reported, with 23% reporting they would avoid going to work, 49% reporting they would avoid using public transport, 42% reporting they would avoid sending children to school, and 52% reporting they would avoid public events. A younger age, a higher concern, and lower confidence in the ability of hospitals to contain the outbreak were significantly associated with both a greater willingness to vaccinate and a larger number of protective behaviors. CONCLUSIONS An Ebola outbreak would have large social and economic consequences owing to the large proportion of the population who intended to avoid social contact in order to protect their health. (Disaster Med Public Health Preparedness. 2016;10:674-680).
TL;DR: A comprehensive, multi-modality approach focused on simulation to teach disaster medicine to emergency medicine residents in a 3-year curriculum to better prepare the nation’s emergency medicine physicians for future disasters is described.
Abstract: OBJECTIVE: Few established curricula are available for teaching disaster medicine. We describe a comprehensive, multi-modality approach focused on simulation to teach disaster medicine to emergency medicine residents in a 3-year curriculum. METHODS: Residents underwent a 3-year disaster medicine curriculum incorporating a variety of venues, personnel, and roles. The curriculum included classroom lectures, tabletop exercises, virtual reality simulation, high-fidelity simulation, hospital disaster drills, and journal club discussion. All aspects were supervised by specialty emergency medicine faculty and followed a structured debriefing. Residents rated the high-fidelity simulations by using a 10-point Likert scale. RESULTS: Three classes of emergency medicine residents participated in the 3-year training program. Residents found the exercise to be realistic, educational, and relevant to their practice. After participating in the program, residents felt better prepared for future disasters. CONCLUSIONS: Given the large scope of impact that disasters potentiate, it is understandably difficult to teach these skills effectively. Training programs can utilize this simulation-based curriculum to better prepare the nation's emergency medicine physicians for future disasters. (Disaster Med Public Health Preparedness. 2016;0:1-4). Language: en
TL;DR: This study proposes the inclusion of a nuclear global health workforce under the technical expertise of the International Atomic Energy Agency and WHO’s Radiation Emergency Medical Preparedness and Assistance Network leadership and supported by the International Health Regulations Treaty.
Abstract: This study argues that any nuclear weapon exchange or major nuclear plant meltdown, in the categories of human systems failure and conflict-based crises, will immediately provoke an unprecedented public health emergency of international concern. Notwithstanding nuclear triage and management plans and technical monitoring standards within the International Atomic Energy Agency and the World Health Organization (WHO), the capacity to rapidly deploy a robust professional workforce with the internal coordination and collaboration capabilities required for large-scale nuclear crises is profoundly lacking. A similar dilemma, evident in the early stages of the Ebola epidemic, was eventually managed by using worldwide infectious disease experts from the Global Outbreak Alert and Response Network and multiple multidisciplinary WHO-supported foreign medical teams. This success has led the WHO to propose the development of a Global Health Workforce. A strategic format is proposed for nuclear preparedness and response that builds and expands on the current model for infectious disease outbreak currently under consideration. This study proposes the inclusion of a nuclear global health workforce under the technical expertise of the International Atomic Energy Agency and WHO's Radiation Emergency Medical Preparedness and Assistance Network leadership and supported by the International Health Regulations Treaty. Rationales are set forth for the development, structure, and function of a nuclear workforce based on health outcomes research that define the unique health, health systems, and public health challenges of a nuclear crisis. Recent research supports that life-saving opportunities are possible, but only if a rapidly deployed and robust multidisciplinary response component exists.
TL;DR: It is found that in disaster responders exposed to traumatic disaster events, the likelihood of probable PTSD can be influenced by individual coping behavior style and other covariates.
Abstract: BACKGROUND: Our knowledge about the impact of coping behavior styles in people exposed to stressful disaster events is limited. Effective coping behavior has been shown to be a psychosocial stress modifier in both occupational and nonoccupational settings. METHODS: Data were collected by using a web-based survey that administered the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian, General Coping Questionnaire-30, and a supplementary questionnaire assessing various risk factors. Logistic regression models were used to test for the association of the 3 coping styles with probable PTSD following disaster exposure among federal disaster responders. RESULTS: In this sample of 549 study subjects, avoidant coping behavior was most associated with probable PTSD. In tested regression models, the odds ratios ranged from 1.19 to 1.26 and 95% confidence intervals ranged from 1.08 to 1.35. With control for various predictors, emotion-based coping behavior was also found to be associated with probable PTSD (odds ratio=1.11; 95% confidence interval: 1.01-1.22). CONCLUSION: This study found that in disaster responders exposed to traumatic disaster events, the likelihood of probable PTSD can be influenced by individual coping behavior style and other covariates. The continued probability of disasters underscores the critical importance of these findings both in terms of guiding mental health practitioners in treating exposed disaster responders and in stimulating future research. (Disaster Med Public Health Preparedness. 2015;0:1-10). Language: en
TL;DR: A participatory intervention effectively improved disaster preparedness at a community level and should be integrated into public health disaster planning to ensure sustainability, according to Disaster Med Public Health Preparedness.
Abstract: OBJECTIVE: The aim of this study was to evaluate the effectiveness of a community-based participatory intervention on earthquake preparedness in Tehran. METHODS: This community-engaged research was conducted during 2011 to 2013. An intervention and a control neighborhood were chosen through systematic cluster sampling. In the intervention group 305 households and in the control group 314 households were sampled for pre- and post-assessment surveys. A participatory intervention was designed on the basis of consultation with the community advisory board and was implemented by trained volunteers. Changes in outcome variables in the intervention and control groups were detected in terms of knowledge, attitude, and practice. Pearson chi-square tests and covariance regression were used to evaluate the effectiveness of the intervention. RESULTS: The results showed that the frequency of earthquake experience in the intervention and control groups was 69.2% and 79.0%, respectively. Moreover, the mean difference scores in knowledge, attitude, and practice in the intervention and control groups before and after the intervention were significant (PCONCLUSIONS: A participatory intervention effectively improved disaster preparedness at a community level. To ensure sustainability, the participatory approach should be integrated into public health disaster planning. (Disaster Med Public Health Preparedness. 2016;0:1-8). Language: en
TL;DR: New York City’s fatal injury profile can inform future coastal storm planning efforts and should focus on older adults, males, and those living in evacuation zones; more evacuation assistance is necessary.
Abstract: OBJECTIVE: This project aimed to describe demographic patterns and circumstances surrounding injury deaths in New York City (NYC) related to Hurricane Sandy. METHODS: Injury deaths related to Hurricane Sandy were classified by using data from multiple sources: NYC's Office of Vital Statistics death records, Office of Chief Medical Examiner case investigation files, and American Red Cross disaster mortality data. Injury deaths were classified as being related to Hurricane Sandy if they were caused directly by the storm's environmental forces or if they were indirectly caused by an interruption of services, displacement, or other lifestyle disruption. RESULTS: We identified 52 injury deaths in NYC related to Hurricane Sandy. Most decedents were male (75%); nearly half were aged 65 years and older (48%). Most (77%) deaths were caused by injuries directly related to Hurricane Sandy. Ninety percent of direct deaths were caused by drowning; most (73%) occurred within 3 days of landfall. Half (50%) of the 12 indirect deaths that occurred up to 30 days after the storm were caused by a fall. Nearly two-thirds (63%) were injured at home. Three-quarters (75%) of fatal injuries occurred in evacuation Zone A. CONCLUSIONS: Risk communication should focus on older adults, males, and those living in evacuation zones; more evacuation assistance is necessary. NYC's fatal injury profile can inform future coastal storm planning efforts. (Disaster Med Public Health Preparedness. 2016;page 1 of 8). Language: en
TL;DR: It is argued that in a number of cases opportunistic leaders, suffering from severe antisocial character disorders, have emerged first as saviors and then as despots, or as common criminals claiming to be patriots, sharing a psychological framework that differs little from those responsible for World War II and the Cold War.
Abstract: The end of the Cold War brought with it many protracted internal conflicts and wars that have lasted for decades and whose persistent instability lies at the heart of both chronic nation-state and regional instability. Responsibility for these chronically failed states has been attributed to multiple unresolved root causes. With previous governance and parties to power no longer trusted or acceptable, the vacuum of leadership in many cases has been filled with "bad leadership." This Concept piece argues that in a number of cases opportunistic leaders, suffering from severe antisocial character disorders, have emerged first as saviors and then as despots, or as common criminals claiming to be patriots, sharing a psychological framework that differs little from those responsible for World War II and the Cold War that followed. I describe the identifying characteristics of this unique and poorly understood subset of the population who are driven to seek the ultimate opportunity to control, dictate, and live out their fantasies of power on the world scene and discuss why their destructive actions remain unabated in the 21st century. Their continued antisocial presence, influence, and levels of violence must be seen as a global security and strategic issue that is not amenable to conventional diplomatic interventions, negotiations, mediations, or international sanctions.
TL;DR: The qualitative findings indicated that the respondents valued learning about common stress responses and incorporating coping as part of a daily routine and the RCHC intervention shows promise and should be investigated further in experimental studies.
Abstract: OBJECTIVE: Community health workers (CHWs) in disaster-affected areas are at risk for emotional distress, as they support others while they may be in the process of rebuilding their own lives. The Resilience and Coping for the Healthcare Community (RCHC) intervention was developed in response to the stress CHWs faced after Hurricane Sandy. The intervention uses psychoeducation to help participants identify common stress responses, recognize signs of job burnout, and utilize healthy coping strategies. METHODS: A mixed-methods pilot of the RCHC intervention was conducted in 2013 with a convenience sample of staff from 6 federally qualified health centers (n=69). Validated measures of stress, coping, compassion fatigue and satisfaction, burnout, stress, and social provisions and a measure of perceived knowledge were administered at baseline, after the workshop, and at a 3-week follow-up. Semi-structured interviews were conducted with 10 randomly selected participants and were analyzed by using content analysis. RESULTS: From baseline to the post-workshop assessment, perceived knowledge scores increased from 24.59 to 30.34, t(62)=5.16 (PCONCLUSIONS: Our qualitative findings indicated that the respondents valued learning about common stress responses and incorporating coping as part of a daily routine. Team building and normalization of emotions were seen as ancillary benefits that would reduce stress levels in the workplace. In conclusion, the RCHC intervention shows promise and should be investigated further in experimental studies. (Disaster Med Public Health Preparedness. 2016;page 1 of 8). Language: en
TL;DR: An overview of the Zika virus infection is presented and presents the historical background of the virus, a description of the pathogen, the epidemiology and clinical spectrum of Zikairus infection, diagnosis and treatment approaches, and prevention and control measures.
Abstract: Since February 2015, Zika virus has spread throughout the Western Hemisphere, starting in Brazil. As of March 2016, autochthonous transmission has been reported in at least 31 countries or territories. For countries in the Americas, the spread of Zika virus, a previously unfamiliar disease, follows similar emerging infection introductions of West Nile virus and Chikungunya virus and their spread throughout the American continents and the Caribbean nations. The Pan American Health Organization and the World Health Organization have issued alerts and a Public Health Emergency of International Concern announcement related to the recent cluster of microcephaly cases and other neurological disorders in Brazil that are temporally associated with Zika virus, which highlights the possible adverse impact of viral infection. This article provides an overview of the Zika virus infection and presents the historical background of the virus, a description of the pathogen, the epidemiology and clinical spectrum of Zika virus infection, diagnosis and treatment approaches, and prevention and control measures. Understanding what is known about the virus and its clinical presentation will assist in prevention, detection, and response measures to reduce and control the spread of the virus throughout the Western Hemisphere. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).
TL;DR: Sandy was associated with a marked increase in hospitalizations for dehydration, and reducing the rate of dehydration following extreme weather events is an important public health concern that needs to be addressed, especially in those over 65 years of age.
Abstract: Objective Hurricane Sandy, one of the most destructive natural disasters in New Jersey history, made landfall on October 29, 2012. Prolonged loss of electrical power and extensive infrastructure damage restricted access for many to food and water. We examined the rate of dehydration in New Jersey residents after Hurricane Sandy. Methods We obtained data from 2008 to 2012 from the Myocardial Infarction Data Acquisition System (MIDAS), a repository of in-patient records from nonfederal New Jersey hospitals (N=517,355). Patients with dehydration had ICD-9-CM discharge diagnosis codes for dehydration, volume depletion, and/or hypovolemia. We used log-linear modeling to estimate the change in in-patient hospitalizations for dehydration comparing 2 weeks after Sandy with the same period in the previous 4 years (2008–2011). Results In-patient hospitalizations for dehydration were 66% higher after Sandy than in 2008–2011 (rate ratio [RR]: 1.66; 95% confidence interval [CI]: 1.50, 1.84). Hospitalizations for dehydration in patients over 65 years of age increased by nearly 80% after Sandy compared with 2008–2011 (RR: 1.79; 95% CI: 1.58, 2.02). Conclusion Sandy was associated with a marked increase in hospitalizations for dehydration. Reducing the rate of dehydration following extreme weather events is an important public health concern that needs to be addressed, especially in those over 65 years of age. (Disaster Med Public Health Preparedness. 2016;10:188–192)
TL;DR: Preparations for an eventual terrorist attack on this unprecedented scale ensured a successful medical response, and contingency plans are being made to face other possible terrorist threats including chemical or biological agents.
Abstract: On Friday, November 13, 2015, Paris was subjected to a multiple terrorist attack that caused widespread carnage. Although French emergency planning, response, and resilience procedures (Plan Blanc) anticipated crisis management of a major incident, these had to be adapted to the local context of Pitie-Salpetriere University Teaching Hospital. Health care workers had undergone Plan Blanc training and exercises and it was fortunate that such a drill had occurred on the morning of the attack. The procedures were observed to work well because this type of eventuality had been fully anticipated, and staff performance exceeded expectations owing to prior in-depth training and preparations. Staff performance was also facilitated by overwhelming staff solidarity and professionalism, ensuring the smooth running of crisis management and improving victim survival rates. Although lessons learned are ongoing, an initial debriefing of managers found organizational improvements to be made. These included improvements to the activation of Plan Blanc and how staff were alerted, bed management, emergency morgue facilities, and public relations. In conclusion, our preparations for an eventual terrorist attack on this unprecedented scale ensured a successful medical response. Even though anticipating the unthinkable is difficult, contingency plans are being made to face other possible terrorist threats including chemical or biological agents. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).
TL;DR: For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM, and a simulation-based comparison suggested that JumpSTart triage outperforms both Smart and CDM.
Abstract: BACKGROUND: It is unclear which pediatric disaster triage (PDT) strategy yields the best accuracy or best patient outcomes. METHODS: We conducted a cross-sectional analysis on a sample of emergency medical services providers from a prospective cohort study comparing the accuracy and triage outcomes for 2 PDT strategies (Smart and JumpSTART) and clinical decision-making (CDM) with no algorithm. Participants were divided into cohorts by triage strategy. We presented 10-victim, multi-modal disaster simulations. A Delphi method determined patients' expected triage levels. We compared triage accuracy overall and for each triage level (RED/Immediate, YELLOW/Delayed, GREEN/Ambulatory, BLACK/Deceased). RESULTS: There were 273 participants (71 JumpSTART, 122 Smart, and 81 CDM). There was no significant difference between Smart triage and CDM. When JumpSTART triage was used, there was greater accuracy than with either Smart (PCONCLUSION: Our simulation-based comparison suggested that JumpSTART triage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM. (Disaster Med Public Health Preparedness. 2016;1-8). Language: en
TL;DR: Predictors for postdisaster wellness may manifest differently across geographic space with concentrations of lower likelihood wellness and increased associations with predictors in areas of higher exposure.
Abstract: OBJECTIVES: To demonstrate a spatial epidemiologic approach that could be used in the aftermath of disasters to (1) detect spatial clusters and (2) explore geographic heterogeneity in predictors for mental health and general wellness. METHODS: We used a cohort study of Hurricane Ike survivors (n=508) to assess the spatial distribution of postdisaster mental health wellness (most likely resilience trajectory for posttraumatic stress symptoms [PTSS] and depression) and general wellness (most likely resilience trajectory for PTSS, depression, functional impairment, and days of poor health) in Galveston, Texas. We applied the spatial scan statistic (SaTScan) and geographically weighted regression. RESULTS: We found spatial clusters of high likelihood wellness in areas north of Texas City and spatial concentrations of low likelihood wellness in Galveston Island. Geographic variation was found in predictors of wellness, showing increasing associations with both forms of wellness the closer respondents were located to Galveston City in Galveston Island. CONCLUSIONS: Predictors for postdisaster wellness may manifest differently across geographic space with concentrations of lower likelihood wellness and increased associations with predictors in areas of higher exposure. Our approach could be used to inform geographically targeted interventions to promote mental health and general wellness in disaster-affected communities. (Disaster Med Public Health Preparedness. 2016;page 1 of 13). Language: en