As Nepal mourns the 1-year commemoration of the April 2015 earthquake and its aftershocks that killed more than 8500 people and left thousands injured and displaced, other more hidden repercussions of the resultant chaotic environment need attention: the increased risk of human trafficking. Considering that natural disasters provide a milieu for this illicit trade, there is a need for a robust response from stakeholders such as donors, civil society organizations, and government organizations against human trafficking following disasters such as the Nepal earthquake. Responsibility to prevent and fight trafficking should be explicitly included in the mandate of relief and rehabilitation mechanisms set up at the national level to coordinate the disaster relief response, serving to support populations in both rural and urban areas. (Disaster Med Public Health Preparedness. 2017;11:153–154)

The purpose of this communication is to explore the implications of genome editing techniques, such as CRISPR/Cas9, on public health–related responses to outbreaks of disease. The recent commercialization of genome editing techniques makes the creation and release of genetically altered pathogens a much easier task, increasing the possibility to the point of needing discussion. Three areas need to be addressed: predictions concerning potential genetic alterations, predictions and implications concerning the release of genetically altered pathogens, and the short- and long-term implications of the release of genetically altered pathogens. Full discourse on these topics among professionals in the area of public health will help to combat harm from the use of any genetically altered biologic weapons. The topics covered here include a review of the CRISPR/Cas9 gene editing technique, including a discussion of which possibilities utilize genome editing. We then address predictions about the application of gene alterations in the context of bioweapons. We discuss a few basic concepts about the evolution of an intentionally released genetically altered organism based on circumstances and patterns gleaned from observing nature in the hope that this will aid in the public health response to bioterrorism attack. (Disaster Med Public Health Preparedness. 2017;11:155–159)

In an effort to enhance education, training, and learning in the disaster health community, the National Center for Disaster Medicine and Public Health (NCDMPH) gathered experts from around the nation in Bethesda, Maryland, on September 8, 2016, for the 2016 Disaster Health Education Symposium: Innovations for Tomorrow. This article summarizes key themes presented during the disaster health symposium including innovations in the following areas: training and education that saves lives, practice, teaching, sharing knowledge, and our communities. This summary article provides thematic content for those unable to attend. Please visit http://ncdmph.usuhs.edu/ for more information. (Disaster Med Public Health Preparedness. 2017;11:160–162)

Zika virus has captivated the world with its quick spread throughout the Western Hemisphere. Increased emphasis has been placed on the infection of pregnant women and subsequent adverse and severe effects in the developing fetus and newborn. This article supplements a previous article and provides updated information on new and evolving evidence that strengthens the association between Zika virus and unique congenital and neurologic diseases, updates what is known about the epidemiology of the disease, and provides new and updated material for primary care providers as they counsel patients who may be exposed or infected. With the extent of disease spread, it is expected that Zika virus will become endemic to the Western Hemisphere and will change the public health parameters and approach in this area of the world. (Disaster Med Public Health Preparedness. 2017;11:163–167)

People may receive tornado warnings from multiple information sources, but little is known about factors that affect the number of warning information sources (WISs). This study examined predictors for the number of WISs with a telephone survey on randomly sampled residents in Tuscaloosa, Alabama, and Joplin, Missouri, approximately 1 year after both cities were struck by violent tornadoes (EF4 and EF5) in 2011. The survey included 1006 finished interviews and the working sample included 903 respondents. Poisson regression and Zero-Inflated Poisson regression showed that older age and having an emergency plan predicted more WISs in both cities. Education, marital status, and gender affected the possibilities of receiving warnings and the number of WISs either in Joplin or in Tuscaloosa. The findings suggest that social disparity affects the access to warnings not only with respect to the likelihood of receiving any warnings but also with respect to the number of WISs. In addition, historical and social contexts are important for examining predictors for the number of WISs. We recommend that the number of WISs should be regarded as an important measure to evaluate access to warnings in addition to the likelihood of receiving warnings. (Disaster Med Public Health Preparedness. 2017;11:168–172)

Studies have documented the impact that hurricanes have on mental health and injury rates before, during, and after the event. Since timely tracking of these disease patterns is crucial to disaster planning, response, and recovery, syndromic surveillance keyword filters were developed by the New York State Department of Health to study the short- and long-term impacts of Hurricane Sandy. Emergency department syndromic surveillance is recognized as a valuable tool for informing public health activities during and immediately following a disaster. Data typically consist of daily visit reports from hospital emergency departments (EDs) of basic patient data and free-text chief complaints. To develop keyword lists, comparisons were made with existing CDC categories and then integrated with lists from the New York City and New Jersey health departments in a collaborative effort. Two comprehensive lists were developed, each containing multiple subcategories and over 100 keywords for both mental health and injury. The data classifiers using these keywords were used to assess impacts of Sandy on mental health and injuries in New York State. The lists will be validated by comparing the ED chief complaint keyword with the final ICD diagnosis code. (Disaster Med Public Health Preparedness. 2017;11:173–178)

The State of Qatar experienced a sandstorm on the night of April 1, 2015, lasting approximately 12 hours, with winds of more than 100 km/h and average particulate matter of approximately 10 μm in diameter. The emergency department (ED) of the main tertiary hospital in Qatar managed 62% of the total emergency calls and those of higher triage order. The peak load of patients during the event manifested approximately 6 hours after the onset. The Major Emergency Command Centre of the hospital ensured the department was maximally organized in terms of disaster management, and established protocols were brought into action. Multiple timely meetings were convened in efforts to effectively execute plans that included rapid emergency medical services handover time, resourcing staff, maximizing bed space, preventing dust entry in the ED, bypassing certain administrative processes, canceling day-surgeries that did not affect inpatient morbidity, and procuring additional respiratory equipment. Patients arrived mainly with exacerbations of asthma and respiratory distress, ophthalmic emergencies, and vehicular trauma; surprisingly, the incidence of pedestrian injuries did not vary. (Disaster Med Public Health Preparedness. 2017;11:227–238)

Carbon monoxide acute intoxication is a common cause of accidental poisoning in industrialized countries and sometimes it produces a real mass casualty incident. The incident described here occurred in a church in the province of Verona, when a group of people was exposed to carbon monoxide due to a heating system malfunction. Fifty-seven people went to the Emergency Department. The mean carboxyhemoglobin (COHb) level was 10.1±5.7% (range: 3-25%). The clinicians, after medical examination, decided to move 37 patients to hyperbaric chambers for hyperbaric oxygen (HBO) therapy. This is the first case report that highlights and analyses the logistic difficulties of managing a mass carbon monoxide poisoning in different health care settings, with a high influx of patients in an Emergency Department and a complex liaison between emergency services. This article shows how it is possible to manage a complex situation with good outcome. (Disaster Med Public Health Preparedness. 2017;11:251–255)

The rapid spread of Zika virus represents a threat to public health and demands significant preparation from hospitals and health care systems. Establishment of procedures for the identification of cases of Zika virus infection is a fundamental aspect of response planning. We describe the steps taken in the development and implementation of a protocol for the diagnosis and management of suspected cases of Zika virus infection in a large academic medical center. (Disaster Med Public Health Preparedness. 2017;11:256–258)

The global community needs to easily identify and respond to new and reemerging threats, such as H1N1, Ebola, and most recently Zika. Clinicians are often the first-line providers to recognize these threats, but yet have few opportunities to learn from each other in real time. In this concept article, we describe the ways clinical information is traditionally shared during a public health emergency and then introduce new mechanisms to facilitate physician communication and learning as a part of the response to Zika. (Disaster Med Public Health Preparedness. 2017;11:259–261)

In November 2014, a total of 164 health care workers were dispatched by the Chinese government as the first medical assistance team to Liberia. The tasks of this team were to establish a China Ebola treatment unit (ETU), to commence the initial admission and treatment of suspected and confirmed Ebola patients, and to provide public health and infection control training for relevant local personnel. Overall, during the 2-month stay of this first medical assistance team in Liberia, 112 Ebola-suspected patients presented to the ETU, 65 patients were admitted, including 5 confirmed cases, and 3 confirmed cases were cured. Furthermore, 1520 local people were trained, including health care workers, military health care workers, staff members employed by the ETU, and community residents. Most importantly, as the first Chinese medical assistance team deployed to Liberia fighting the Ebola virus on the frontline, not a single member of this team or the hired local staff were infected by Ebola virus. This highly successful outcome was due to the meticulous infection control initiatives developed by the team, thereby making a significant contribution to China’s ETU “zero infection” of health workers in Liberia. The major infection control initiatives conducted in the China ETU that contributed to achieving “zero infection” of all health workers in the ETU are introduced in this report. (Disaster Med Public Health Preparedness. 2017;11:262–266)

In September 2015, Pope Francis visited Philadelphia, Pennsylvania, and led outdoor events over the course of 2 days. As a result, The Children’s Hospital of Philadelphia (CHOP) was faced with the challenge of planning for and responding to a mass gathering that was anticipated to be one of the largest in US history. As a result of unprecedented traffic restrictions, it was anticipated that patients, staff, and vendors would have severe challenges accessing the hospital, along with impaired communications from widespread cell phone service disruption. Previous mass gatherings have proven a need for early, detailed planning with multidisciplinary stakeholders, but little has been published on the impact of mass gatherings on area hospitals. This lack of data makes it difficult to predict the extent to which demand for hospital services would be increased and which services would be most affected. Early, coordinated planning allowed CHOP leaders to delegate responsibilities to those with specific expertise, prioritize needs, prevent duplication of efforts, and ensure engagement and accountability from key stakeholders. Emergency preparedness-led efforts including housing almost 1000 employees for 3 consecutive nights and assisting families with access allowed our hospital to maintain operations. The planning strategies shared here will provide emergency preparedness planners with a blueprint for future mass gathering preparedness. (Disaster Med Public Health Preparedness. 2017;11:267–276)