The Chernobyl disaster in 1986 involved the largest airborne release of radioactivity in history, more than 100 times as much radioactivity as the Hiroshima and Nagasaki atomic bombs together. The resulting emergency response, administrative blunders, and subsequent patient outcomes from this large-scale radiological disaster provide a wealth of information and valuable lessons for those who may find themselves having to deal with the staggering consequences of nuclear war. Research findings, administrative strategies (successful and otherwise), and resulting clinical procedures from the Chernobyl experience are reviewed to determine a current utility in addressing the appropriate protocols for a medical response to nuclear war. As various myths are still widely associated with radiation exposure, attention is given to the realities of a mass casualty medical response as it would occur with a nuclear detonation.

(Disaster Med Public Health Preparedness. 2012;6:330-334)

Objective: To build a tool to assist disaster response planning and estimate the numbers of displaced persons that will require special medical care during a disaster.

Methods: We developed a tool, titled MedCon:PreEvent, which incorporates data from the 2006 National Health Interview Survey, 2005 National Hospital Discharge Survey, and 2004 National Nursing Home Survey to calculate numbers of emergency room/emergency department (ER/ED) visits, surgeries, health care home visits, overnight hospital stays, office visits, and self-rated health status. We then used thresholds of more than 12 office visits or 6 or more ER/ED visits or 6 or more surgeries or more than 4 home visits or more than 6 overnight hospital stays within the past 12 months to calculate rates per million evacuees requiring special medical care, including daily bed hospital and nursing home bed occupancy.

Results: We calculated that 79 428 (95% CI = 76 940-81 770) per million evacuees would need special medical care. The daily occupation of hospital beds would be 1710 beds (95% CI = 1328-2160) per million. The occupation of nursing home beds would be 5094 beds (95% CI = 5040-5148) per million. Changing the threshold to just those who self-rated health as “poor,” the demand for special medical care would be 24 348 (95% CI = 23 087-25 535) per million. Using threshold utilization values at half the original level would increase the estimate to 226 988 (95% CI = 224 444-229 384) per million.

Conclusions: A substantial number of persons with preexisting conditions will need suitable medical care following a disaster. The MedCon:PreEvent tool can assist disaster planners to prepare for medical care needs of large numbers of evacuees and consider re-evaluating the approach to utilizing and augmenting medical care services.

(Disaster Med Public Health Preparedness. 2012;6:335–341)

Objective: Disaster preparedness has become a health policy priority for the United States in the aftermath of the anthrax attacks, 9/11, and other calamities. It is important for rural health care professionals to be prepared for a bioterrorist attack or other public health emergency. We sought to determine the barriers impeding rural physicians from being prepared for a human-induced disaster such as a bioterrorist attack.

Methods: This study employed a qualitative methodology using key informant interviews followed by grounded theory methods for data analysis. Semistructured interviews were conducted with 6 physicians in the state of Florida from federally designated rural areas.

Results: The interview participants articulated primary barriers and the associated factors contributing to these barriers that may affect rural physician preparedness for human-induced emergencies. Rural physicians identified 3 primary barriers: accessibility to health care, communication between physicians and patients, and rural infrastructure and resources. Each of these barriers included associated factors and influences. For instance, according to our participants, access to care was affected by a lack of health insurance, a lack of finances for health services, and transportation difficulties.

Conclusions: Existing rural organizational infrastructure and resources are insufficient to meet current health needs owing to a number of factors including the paucity of health care providers, particularly medical specialists, and the associated patient-level barriers. These barriers presumably would be exacerbated in the advent of a human-induced public health emergency. Thus, strategically implemented health policies are needed to mitigate the barriers identified in this study.

(Disaster Med Public Health Preparedness. 2012;6:342–348)

Objective: Although the field of crisis risk communication has generated substantial research, the interaction between social determinants, communication processes, and behavioral compliance has been less well studied. With the goal of better understanding these interactions, this report examines how social determinants influenced communications and behavioral compliance during the 2010 Boston, Massachusetts, water crisis.

Methods: An online survey was conducted to assess Boston residents' knowledge, beliefs, attitudes, mass and interpersonal communication, and preventive behaviors on emergency preparedness topics dealing with the water crisis. Of a total sample of 726 respondents, approximately one-third (n = 267) reported having been affected by the water crisis. Only data from affected participants were analyzed.

Results: Following an order to boil water, 87.5% of respondents refrained from drinking unboiled tap water. These behaviors and other cognitive and attitudinal factors, however, were not uniform across population subgroups. All communication and behavioral compliance variables varied across sociodemographic factors.

Conclusions: Crisis communication, in conjunction with other public health preparedness fields, is central to reducing the negative impact of sudden hazards. Emergency scenarios such as the Boston water crisis serve as unique opportunities to understand how effectively crisis messages are conveyed to and received by different segments of the population.

(Disaster Med Public Health Preparedness. 2012;6:349-356)

Objective: The Cities Readiness Initiative is a federally funded program designed to assist 72 metropolitan statistical areas (MSAs) in preparing to dispense life-saving medical countermeasures within 48 hours of a public health emergency. Beginning in 2008, the 72 MSAs were required to conduct 3 drills related to the distribution and dispensing of emergency medical countermeasures. The report describes the results of the first year of pilot data for medical countermeasure drills conducted by the MSAs.

Methods: The MSAs were provided templates with key metrics for 5 functional elements critical for a successful dispensing campaign: personnel call down, site activation, facility setup, pick-list generation, and dispensing throughput. Drill submissions were compiled into single data sets for each of the 5 drills. Analyses were conducted to determine whether the measures were comparable across business and non-business hours. Descriptive statistics were computed for each of the key metrics identified in the 5 drills.

Results: Most drills were conducted on Mondays and Wednesdays during business hours (8:00 am-5:00 pm). The median completion time for the personnel call-down drill was 1 hour during business hours (n = 287) and 55 minutes during non-business hours (n = 136). Site-activation drills were completed in a median of 30 minutes during business hours and 5 minutes during non-business hours. Facility setup drills were completed more rapidly during business hours (75 minutes) compared with non-business hours (96 minutes). During business hours, pick lists were generated in a median of 3 minutes compared with 5 minutes during non-business hours. Aggregate results from the dispensing throughput drills demonstrated that the median observed throughput during business hours (60 people/h) was higher than that during non-business hours (43 people/h).

Conclusion: The results of the analyses from this pilot sample of drill submissions provide a baseline for the determination of a national standard in operational capabilities for local jurisdictions to achieve in their planning efforts for a mass dispensing campaign during an emergency.

(Disaster Med Public Health Preparedness. 2012;6:357–362)

Objective: The incidence, types, and influencing factors of injuries due to snow-ice disasters are essential for public health preparedness. This study was designed to assess such factors of injuries during the 22-day snowstorm in Ningbo, Zhejiang Province, China, in 2008.

Methods: A multistage cluster probability sampling method was applied to select the study population in urban, rural, and mountainous areas. Data including sociodemographic characteristics, frequency, and types of injuries during the snowstorm between January 20 and February 10, 2008, were obtained by face-to-face interviews using a structured questionnaire and by checking the participants' medical records. Univariate and multivariate regression analyses were used to determine the factors significantly associated with the risk of injuries.

Results: A total of 3169 residents of 1416 families took part in this survey. In 581 residents, 602 injuries were identified. Incidences of frostbite, falling injury, and traffic accident–related injury were 12.78%, 5.30%, and 0.50%, respectively. Injury occurred more frequently in women than in men (odds ratio [OR], 1.42; 95% CI, 1.19-1.70). Frostbite occurred more frequently in women than in men (adjusted OR, 1.86; 95% CI, 1.43-2.41) and more frequently in urban areas than in other areas (adjusted OR, 1.65; 95% CI, 1.24-2.20). Travel by bus or car, wearing a scarf, wearing gloves, wearing a raincoat, reducing outdoor activity, and performing regular physical exercise were independent protective factors of frostbite, with an adjusted OR (95% CI) of 0.35 (0.20-0.61), 0.45 (0.33-0.62), 0.35 (0.26-0.48), 0.45 (0.33-0.61), 0.36 (0.27-0.48), and 0.18 (0.13-0.24), respectively. Falling injury occurred more often in mountainous areas than in other areas (adjusted OR, 1.74; 95% CI, 1.27-2.42). Age 45 years or older, working outside more than 15 days, and wearing a raincoat were independent risk factors of falling injury, with an adjusted OR (95% CI) of 2.30 (1.60-3.32), 1.92 (1.36-2.72), and 2.21 (1.56-3.11), respectively. Falling and traffic accident–related injuries were mainly due to slippery roads.

Conclusions: Frostbite and falling injury were the major injuries caused by an unprecedented snow-ice disaster. Keeping warm and maintaining regular physical exercise appeared to reduce frostbite risk. Public health intervention also reduced the risk of falling and traffic accident–related injuries.

(Disaster Med Public Health Preparedness. 2012;6:363-369)

Objective: The Haitian earthquake of January 12, 2010, was a disaster essentially unprecedented in the Western Hemisphere's recorded history. The USNS Comfort departed from Baltimore, Maryland, within 72 hours of the earthquake and arrived in Port-au-Prince harbor on January 19. During the subsequent 40 days, the ship provided one of the largest relief efforts in the US Navy's history.

Methods: The data analyzed included all patients evaluated and treated by the USNS Comfort between January 19 and February 27, 2010. A medical chart with a unique identifier was created for each patient on admission. A patient database was created from these records and used for this analysis.

Results: A total of 872 patients and 185 patient escorts were processed aboard the ship. Ages ranged from younger than 1 day to 89 years: 635 were adults and 237 were children. Of those admitted, 817 of the patients were admitted for longer than 24 hours; the average length of stay was 8.0 days. The need for surgery was substantial: 454 patients went to the operating room (OR) 843 times for 927 cumulative procedures. A total of 58 patients underwent amputations.

Conclusions: Haiti was almost completely reliant on foreign medical teams for trauma care. Analysis of the data illustrates the challenges of triage and treatment in a humanitarian mass-casualty response. The remarkable coordination and cooperation among the Haitian Ministry of Health, nongovernmental humanitarian aid organizations, and the US military highlighted the responders' respective capabilities and demonstrated the importance of collaboration in future disaster response efforts.

(Disaster Med Public Health Preparedness. 2012;6:370–377)

Objective: Nonpharmacologic interventions such as limiting nosocomial spread have been suggested for mitigation of respiratory epidemics at health care facilities. This observational study tested the efficacy of a mass screening, isolation, and triage protocol in correctly identifying and placing in a cohort exercise subjects according to case status in the emergency departments at 3 acute care hospitals in Brooklyn, New York, during a simulated pandemic influenza outbreak.

Methods: During a 1-day, full-scale exercise using 354 volunteer victims, variables assessing adherence to the mass screening protocol and infection control recommendations were evaluated using standardized forms.

Results: While all hospitals were able to apply the suggested mass screening protocol for separation based on case status, significant differences were observed in several infection control variables among participating hospitals and different hospital areas.

Conclusions: Implementation of mass screening and other infection control interventions during a hospital full-scale exercise was feasible and resulted in measurable outcomes. Hospital drills may be an effective way of detecting and addressing variability in following infection control recommendations.

(Disaster Med Public Health Preparedness. 2012;6:378-384)

Objective: Older persons have levels of frailty and disability that place them at far greater risk of harm in disasters than younger adults, making it crucial for all agency planners, public health workers, and health care providers to be aware of age-appropriate considerations of preparedness and response. This research evaluated the knowledge and utilization intentions of participants of a geriatric emergency preparedness and response (GEPR) continuing education program that was designed to provide this training.

Methods: A qualitative training evaluation was conducted using course evaluation questionnaires from GEPR workshops offered in 2009 in 7 nationwide cities through a partnership of the University of Texas Center for Biosecurity and Public Health Preparedness with the Texas Consortium Geriatric Education Center at Baylor College of Medicine, Houston.

Results: Evaluations were completed by 292 participants. Respondents were able to name specific information learned, give examples of applications of the material, and devise plans for further action. Participants believed that their ability to do their jobs had increased, and they provided insightful suggestions instructive to both trainers and to leaders of health care organizations.

Conclusions: The results of the evaluation suggest that GEPR workshops are effective in increasing the knowledge of participants and their intentions to use it. There is both a need and a demand for this training. Developers and trainers should provide participants with sufficient time for absorbing the information, consider tailoring the training to the local context, and provide opportunity for practical application, particularly planning exercises.

(Disaster Med Public Health Preparedness. 2012;6:385-392)

Objectives: One of the most striking features of the ongoing conflict in the Democratic Republic of Congo (DRC) is the use of sexual violence. In spite of the brutality of these crimes, the experiences of women affected by sexual violence in Eastern DRC remain poorly characterized. This analysis aimed to (1) provide detailed demographics of sexual violence survivors presenting to Panzi Hospital; (2) examine how demographic factors might impact patterns of sexual violence; and (3) describe care-seeking behavior among sexual violence survivors.

Methods: The demographics and care-seeking behavior of sexual violence survivors in South Kivu Province were described from a retrospective registry-based study of sexual violence survivors presenting to Panzi Hospital (2004-2008).

Results: A total of 4311 records were reviewed. The mean age of survivors was 35 years. Most women (53%) were married, self-identified with the Bashi tribe (65%), and reported agriculture as their livelihood (74%). The mean time delay between sexual assault and seeking care was 10.4 months. Five reasons were identified to help explain the lengthy delays to seeking care: waiting for physical symptoms to develop or worsen before seeking medical attention, lack of means to access medical care, concerns that family would find out about the sexual assault, stigma surrounding sexual violence, and being abducted into sexual slavery for prolonged periods of time.

Conclusions: Many sexual assault survivors have very delayed presentations to medical attention. Promoting timely access of medical care may best be facilitated by reducing stigma and by educating women about the benefits of early medical care, even in the absence of injuries or symptoms.

(Disaster Med Public Health Preparedness. 2012;6:393-401)

In 2009, a monovalent H1N1 influenza (H1N1) vaccine was manufactured in response to the pandemic of 2009 influenza A (H1N1) virus infection that emerged earlier in the year. The overall allocation of the H1N1 vaccine to the states was the purview of the federal government; thereafter, the states were accountable for distributing and reporting the number of doses of H1N1 vaccine administered weekly. This report describes how the Wisconsin Immunization Registry (WIR) was updated and used during the H1N1 immunization campaign and its role in meeting the federal H1N1 immunization reporting requirements. Activities to enhance the registry's functionality included the creation of a rapid data entry screen for providers to facilitate the entry of data into the WIR, and enhancing the reporting capabilities of the WIR to generate H1N1-related reports at the local level. Results of these activities included an increase in the number of WIR users, higher reported numbers of seasonal influenza doses administered, and the establishment of data streams from new users. Data completeness, the ability to accurately forecast doses needed, and validating administered doses were challenges in the changing environment.

(Disaster Med Public Health Preparedness. 2012;6:402-407)

The user-managed inventory (UMI) is an emerging idea for enhancing the current distribution and maintenance system for emergency medical countermeasures (MCMs). It increases current capabilities for the dispensing and distribution of MCMs and enhances local/regional preparedness and resilience. In the UMI, critical MCMs, especially those in routine medical use (“dual utility”) and those that must be administered soon after an incident before outside supplies can arrive, are stored at multiple medical facilities (including medical supply or distribution networks) across the United States. The medical facilities store a sufficient cache to meet part of the surge needs but not so much that the resources expire before they would be used in the normal course of business. In an emergency, these extra supplies can be used locally to treat casualties, including evacuees from incidents in other localities. This system, which is at the interface of local/regional and federal response, provides response capacity before the arrival of supplies from the Strategic National Stockpile (SNS) and thus enhances the local/regional medical responders' ability to provide life-saving MCMs that otherwise would be delayed. The UMI can be more cost-effective than stockpiling by avoiding costs due to drug expiration, disposal of expired stockpiled supplies, and repurchase for replacement.

(Disaster Med Public Health Preparedness. 2012;6:408-414)

Few regions of the world are at higher risk for environmental disasters than the Pacific Island countries and territories. During 2004 and 2005, the top public health leadership from 19 of 22 Pacific Island countries and territories convened 2 health summits with the goal of developing the world's first comprehensive regional strategy for sustainable disaster risk management as applied to public health emergencies. These summits followed on the objectives of the 1994 Barbados Plan of Action for the Sustainable Development of Small Island Developing States and those of the subsequent Yokohama Strategy and Plan of Action for a Safer World. The outputs of the 2004 and 2005 Pacific Health Summits for Sustainable Disaster Risk Management provide a detailed description of challenges and accomplishments of the Pacific Island health ministries, establish a Pacific plan of action based upon the principles of disaster risk management, and provide a locally derived, evidence-based approach for many climate change adaptation measures related to extreme weather events in the Pacific region. The declaration and outputs from these summits are offered here as a guide for developmental and humanitarian assistance in the region (and for other small-island developing states) and as a means for reducing the risk of adverse health effects resulting from climate change.

(Disaster Med Public Health Preparedness. 2012;6:415-423)

Almost 2 million Americans rely on nursing homes for care, and many require daily or near daily contact with the health care system to remain alive and functional. In October 2007, Southern California experienced a series of wildfires that burned over 500 000 acres and caused 14 nursing homes to evacuate more than 1200 residents. In response to this event, nursing home administrators and officials from various health care and emergency management agencies in San Diego County collaborated to form a model for nursing home emergency preparedness. This report describes the model, known as the area coordinator system, and discusses its strengths and limitations, and whether it ought to be replicated in other areas of the country.

(Disaster Med Public Health Preparedness. 2012;6:424-427)

Collapsed structures, typically as a result of earthquakes, may result in individuals entrapped by their limbs under heavy structural elements. In addition, access to living persons may be blocked by the deceased. Individuals are often critically ill by the time they are found, and rapid extrication is warranted. This and other factors may necessitate field amputation of an extremity on a living person or dismemberment of the deceased to achieve a rescue. Although case reports have described industrial, mining, and transportation accidents, few discuss this potential in collapsed structures. Also, few specifically outline the indications or the decision process and associated administrative procedures that should be addressed before conducting these procedures. This report presents a review of the literature along with a limited case series. A discussion regarding relevant decision making is provided to encourage the development of protocols. An international consensus statement on these procedures is provided.

(Disaster Med Public Health Preparedness. 2012;6:428-435)