To elucidate the impacts of nuclear plant accidents on neighboring medical centers, we investigated the operations of our hospital within the first 10 days of the Great East Japan Earthquake followed by the Fukushima Daiichi nuclear power plant accident.

Data were extracted from medical records and hospital administrative records covering 11 to 20 March 2011. Factual information on the disaster was obtained from public access media.

A total of 622 outpatients and 241 inpatients were treated. Outpatients included 43 injured, 6 with cardiopulmonary arrest, and 573 with chronic diseases. Among the 241 inpatients, 5 died, 137 were discharged, and the other 99 were transferred to other hospitals. No communication methods or medical or food supplies were available for 4 days after the earthquake. Hospital directors allowed employees to leave the hospital on day 4. All 39 temporary workers were evacuated immediately, and 71 of 239 full-time employees remained. These employees handled extra tasks besides patient care and patient transfer to other hospitals. Committed effective doses indicating the magnitude of health risks due to an intake of radioactive cesium into the human body were found to be minimal according to internal radiation exposure screening carried out from July to August 2011.

After the disaster, hospitals located within the evacuation zone of a 30-km radius of the nuclear power plant were isolated. Maintenance of the health care system in such an event becomes difficult. (Disaster Med Public Health Preparedness. 2014;8:471-476)

The objective of this study was to draft a new Japanese Disaster Medical Assistance Team (DMAT) training program based on the responses to the Great East Japan Earthquake.

Working group members of the Japan DMAT Investigative Commission, Ministry of Health, Labour and Welfare, reviewed reports and academic papers on DMAT activities after the disaster and identified items in the current Japanese DMAT training program that should be changed. A new program was proposed that incorporates these changes.

New topics that were identified to be added to the DMAT training program were hospital evacuation, preparations to receive DMATs at damaged hospitals, coordination when DMAT activities are prolonged, and safety management and communication when on board small helicopters. The use of wide-area transport was reviewed and changes were made to cover selection of various transport means including helicopter ambulances. Content related to confined space medicine was removed. The time spent on emergency medical information system (EMIS) practical training was increased. Redundant or similar content was combined and reorganized, and a revised DMAT training program that did not increase the overall training time was designed.

The revised DMAT training program will provide practical training better suited to the present circumstances in Japan. (Disaster Med Public Health Preparedness. 2014;8:477-484)

Tropical Cyclone Yasi in North Queensland activated the disaster management plans at The Townsville Hospital, including the establishment of an emergency child minding service to facilitate the return of staff to work.

This report describes the establishment of this service and the results of brief electronic surveys that were distributed in the 2 weeks following the cyclone to gather feedback from staff who had placed their children in the care of the service (consumers), staff who had manned the service (staff), and allied health managers whose staff had manned the service (managers).

Overall, approximately 94 episodes of care were provided by the child minding service. All consumers responded “‘yes’” in answer to the question of whether the emergency child minding service facilitated their return to work in the immediate post-disaster period. The survey also identified that a lack of effective advertising may have prevented further uptake of the child minding service.

The provision of an emergency child minding service facilitated the return to work of health care staff immediately after Tropical Cyclone Yasi. More research is needed to understand the effect disaster type has on the uptake of a child minding service. (Disaster Med Public Health Preparedness. 2014;8:485-488)

We briefly describe 2 systems that provided disaster-related mortality surveillance during and after Hurricane Sandy in New York City, namely, the New York City Health Department Electronic Death Registration System (EDRS) and the American Red Cross paper-based tracking system.

Red Cross fatality data were linked with New York City EDRS records by using decedent name and date of birth. We analyzed cases identified by both systems for completeness and agreement across selected variables and the time interval between death and reporting in the system.

Red Cross captured 93% (41/44) of all Sandy-related deaths; the completeness and quality varied by item, and timeliness was difficult to determine. The circumstances leading to death captured by Red Cross were particularly useful for identifying reasons individuals stayed in evacuation zones. EDRS variables were nearly 100% complete, and the median interval between date of death and reporting was 6 days (range: 0-43 days).

Our findings indicate that a number of steps have the potential to improve disaster-related mortality surveillance, including updating Red Cross surveillance forms and electronic databases to enhance timeliness assessments, greater collaboration across agencies to share and use data for public health preparedness, and continued expansion of electronic death registration systems. (Disaster Med Public Health Preparedness. 2014;8:489-491)

An excess of deaths from cardiac causes are reported after many natural disasters. Despite the fact that floods are the most common and most destructive natural disaster worldwide, little is known about their effect on human health. We analyzed the influence of the greatest floods in the Czech Republic on cardiac mortality in the affected area.

This was a retrospective case-control study. We analyzed persons whose autopsies proved they had died of cardiac causes during the month of the flood, 2 months before the flood, 1 month after the flood, and during the same period in the 3 previous years.

A total of 207 of 985 autopsy reports met the criteria for inclusion in the study. There were no significant differences in the proportions of men and women (P=0.819) or in age (P=0.577). During the month of the flood, an increase in cardiac mortality was observed; however, the increase was not statistically significant (P=0.088).

According to our findings, the 1997 Central European flood did not significantly affect cardiac mortality. (Disaster Med Public Health Preparedness. 2014;8:492-496)

We propose a model of population behavior in the aftermath of disasters.

We conducted a qualitative analysis of an empirical dataset of 339 disasters throughout the world spanning from 1950 to 2005.

We developed a model of population behavior that is based on 2 fundamental assumptions: (i) behavior is predictable and (ii) population behavior will progress sequentially through 5 stages from the moment the hazard begins until is complete.

Understanding the progression of population behavior during a disaster can improve the efficiency and appropriateness of institutional efforts aimed at population preservation after large-scale traumatic events. Additionally, the opportunity for population-level intervention in the aftermath of such events will improve population health. (Disaster Med Public Health Preparedness. 2014;8:497-504)

The Incident Command System (ICS) is an adaptable construct designed to streamline response efforts to a disaster or other incident. We aimed to examine the methods used to teach the ICS at US veterinary schools and to explore alternative and novel methods for instruction of this material.

A total of 29 US accredited veterinary schools (as of February 2012) were surveyed, and 18 of the 29 schools responded.

The ICS and related topics were taught by both classroom methods and online instruction by most of the surveyed schools. Several of the schools used readily available Federal Emergency Management Agency and US Department of Agriculture resources to aid in instruction. Most schools used one course to teach the ICS, and some schools also used unique methods such as field exercises, drills, side-by-side training with disaster response teams, elective courses, extracurricular clubs, and externships to reinforce the ICS and related topics. Some of the surveyed institutions also utilized fourth-year clinical rotations and field deployments during actual disasters as a component of their ICS and emergency response curriculum.

The ICS is being taught at some form at a significant number of US veterinary schools. Additional research is needed to evaluate the efficacy of the teaching methods of the ICS in US veterinary schools. (Disaster Med Public Health Preparedness. 2014;8:505-510)

Working within a series of partnerships among an academic health center, local health departments (LHDs), and faith-based organizations (FBOs), we validated companion interventions to address community mental health planning and response challenges in public health emergency preparedness.

We implemented the project within the framework of an enhanced logic model and employed a multi-cohort, pre-test/post-test design to assess the outcomes of 1-day workshops in psychological first aid (PFA) and guided preparedness planning (GPP). The workshops were delivered to urban and rural communities in eastern and midwestern regions of the United States. Intervention effectiveness was based on changes in relevant knowledge, skills, and attitudes (KSAs) and on several behavioral indexes.

Significant improvements were observed in self-reported and objectively measured KSAs across all cohorts. Additionally, GPP teams proved capable of producing quality drafts of basic community disaster plans in 1 day, and PFA trainees confirmed upon follow-up that their training proved useful in real-world trauma contexts. We documented examples of policy and practice changes at the levels of local and state health departments.

Given appropriate guidance, LHDs and FBOs can implement an effective and potentially scalable model for promoting disaster mental health preparedness and community resilience, with implications for positive translational impact.(Disaster Med Public Health Preparedness. 2014;8:511-526)

The success of the Medical Reserve Corps (MRC) is dependent on the ability of volunteers to respond in a timely and effective manner. This study aimed to assess the current status of MRC volunteer training and to examine the association between MRC characteristics and provision of training.

The data for this study were drawn from the 2013 Network Profile Survey of the MRC, which was administered to active MRC unit leaders or designated alternates of 962 units across the country in April to May of 2013.

Over 80% of MRCs had a training plan. Ninety-one percent of MRCs offered one or more training courses to volunteers, and 73% indicated requirements for mandatory training. Approximately 84% of MRC units collaborated with other organizations to conduct trainings. Units with more volunteers (>150) were 3 times as likely to have a plan for volunteer training as were those with fewer volunteers (≤50). Compared to units with a full-time leader, those with leaders who were volunteers were only 0.57 times as likely to have a training plan.

An overwhelming majority of MRC units provide critical training to their volunteers prior to an emergency deployment. To further strengthen the overall MRC capacities, it is important for MRC units to have a training plan tailored to their community needs and features, make full use of available training resources, and collaborate with partner organizations. (Disaster Med Public Health Preparedness. 2014;8:527-532)

Individuals with disabilities experience more negative outcomes due to natural and manmade disasters and emergencies than do people without disabilities. This vulnerability appears to be due in part to knowledge gaps among public health and safety emergency planning and response personnel (responders). We assessed the effectiveness of an online program to increase emergency responder knowledge about emergency planning and response for individuals with disabilities.

Researchers developed an online course designed to teach public health, emergency planning and management, and other first response personnel about appropriate, efficient, and equitable emergency planning, response, interaction, and communication with children and adults with disabilities before, during, and after disasters or emergencies. Course features included an ongoing storyline, exercises embedded in the form of real-life scenarios, and game-like features such as points and timed segments.

Evaluation measures indicated significant pre- to post-test gains in learner knowledge and simulated applied skills.

An online program using scenarios and simulations is an effective way to make disability-related training available to a wide variety of emergency responders across geographically disparate areas. (Disaster Med Public Health Preparedness. 2014;8:533-540)

We aimed to compare injury characteristics and the timing of admissions and surgeries in the Wenchuan earthquake in 2008 and the Lushan earthquake in 2013.

We retrospectively compared the admission and operating times and injury profiles of patients admitted to our medical center during both earthquakes. We also explored the relationship between seismic intensity and injury type.

The time from earthquake onset to the peak in patient admissions and surgeries differed between the 2 earthquakes. In the Wenchuan earthquake, injuries due to being struck by objects or being buried were more frequent than other types of injuries, and more patients suffered injuries of the extremities than thoracic injuries or brain trauma. In the Lushan earthquake, falls were the most common injury, and more patients suffered thoracic trauma or brain injuries. The types of injury seemed to vary with seismic intensity, whereas the anatomical location of the injury did not.

Greater seismic intensity of an earthquake is associated with longer delay between the event and the peak in patient admissions and surgeries, higher frequencies of injuries due to being struck or buried, and lower frequencies of injuries due to falls and injuries to the chest and brain. These insights may prove useful for planning rescue interventions in trauma centers near the epicenter. (Disaster Med Public Health Preparedness. 2014;8:541-547)

This study aimed to clarify the management of emergency electric power and the operation of radiology diagnostic devices after the Great East Japan Earthquake.

Timing of electricity restoration, actual emergency electric power generation, and whether radiology diagnostic devices were operational and the reason if not were investigated through a questionnaire submitted to all 14 disaster base hospitals in Miyagi Prefecture in February and March 2013.

Commercial electricity supply resumed within 3 days after the earthquake at 13 of 14 hospitals. Actual emergency electric power generation was lower than pre-disaster estimates at most of the hospitals. Only 4 of 11 hospitals were able to generate 60% of the power normally consumed. Under emergency electric power, conventional X-ray and computed tomography (CT) scanners worked in 9 of 14 (64%) and 8 of 14 (57%) hospitals, respectively. The main reason conventional X-ray and CT scanners did not operate was that hospitals had not planned to use these devices under emergency electric power. Only 2 of the 14 hospitals had a pre-disaster plan to allocate emergency electric power, and all devices operated at these 2 hospitals.

Pre-disaster plans to allocate emergency electric power are required for disaster base hospitals to effectively operate radiology diagnostic devices after a disaster. (Disaster Med Public Health Preparedness. 2014;8:548-552)