Pandemics generate such a significant demand for care that traditional triage methods can become saturated. Secondary population-based triage (S-PBT) overcomes this limitation. Although the coronavirus disease (COVID-19) pandemic forced S-PBT into operation internationally during the first year of the pandemic, Australian doctors were spared this responsibility. However, the second wave of COVID-19 provides an opportunity to explore the lived experience of preparing for S-PBT within the Australian context.

The aim of this study is to explore the lived experience of preparing to operationalize S-PBT to allocate critical care resources during Australia’s second wave of COVID-19 in 2020.

Intensivists and emergency physicians working during the second Victorian COVID-19 surge were recruited by purposive non-random sampling. Semi-structured interviews were hosted remotely, recorded, transcribed, and coded to facilitate a qualitative phenomenological analysis.

Six interviews were conducted with an equal mix of intensivists and emergency doctors. Preliminary findings from a thematic analysis revealed 4 themes: (1) threat of resources running; (2) informed decision requiring information; (3) making decisions as we always do; and (4) a great burden to carry.

This is the first description of this novel phenomenon within Australia and, in doing so, it identified a lack of preparedness to operationalize S-PBT during the second wave of COVID-19 in Australia.

The purpose of this study was to analyze the cost-effectiveness of helicopter emergency medical services (HEMS) for its economic operations in South Korea.

This study targeted trauma patients that were transported by either HEMS or ground emergency medical services (GEMS) from the scene of an accident to a regional emergency medical center. From this patient population, severe trauma patients (injury severity score ISS ≥ 16 points) with a distance travelled from the scene of the injury to the hospital that was 30 km or longer and with analyzable outcome data were extracted and included in this study. Cost-effectiveness was analyzed from survival and efficiency based on medical costs incurred from the pre-hospital setting to hospital discharge. This study included a total of 34 HEMS and 105 GEMS patients with an Injury Severity Score (ISS) ≥ 16 points from a pool of 357 potential patients.

The survival-to-discharge rate of HEMS was 29 of 34 patients (85.3%) and was significantly higher than that of GEMS, where only 66 of 105 patients (62.8%) survived to discharge (P = 0.024). The expected and the actual mortality was higher in HEMS than it was in GEMS. Statistical significant difference in cost was found between the 2 groups (P = 0.002).

The results of the present study indicate the increased discharge rate, survival rate and reduced in hospital mortality of HEMS with reduced admission time. This result association leads to reasonable cost effectiveness and efficient estimates overall.

The purpose of this article was to examine the psychometric properties of the Crisis Counseling Assistance and Training Program (CCP) data collection instrument, the Individual/Family Encounter Log (IFEL). Data collected from disaster survivors included how they reacted to events in emotional, behavioral, physical, and cognitive domains. These domains are based on conceptual categorization of event reactions and allow CCP staff to provide survivors with referrals to appropriate behavioral health support resources, if warranted.

This study explored the factor structure of these survey items to determine how best to use the available information as a screen of disaster-related behavioral health indicators. Specifically, our first research question explored and confirmed the optimal factor structure of the event reaction items, and our second question examined whether the new factor structure was similar across disaster types: hurricanes, tornadoes, floods, and wildfires. Using a factor analytic technique, we tested whether our event reaction outcomes achieved consistent and reliable measurement across different disaster situations. Finally, we assessed how the new subscales were correlated with the type of risk to which CCP disaster survivors were exposed.

Our analyses revealed 3 factors: (1) depressive-like, (2) anxiety-like, and (3) somatic. In addition, we found that these factors were coherent for hurricanes, floods, and wildfires, although the basic factor structure was not equivalent for tornadoes.

Implications for use of the IFEL in disaster preparedness, response, and recovery are discussed. (Disaster Med Public Health Preparedness. 2016;10:822–831)

Study the effect of the coronavirus disease (COVID-19) pandemic on emergency room (ER) utilization for musculoskeletal (MSK) complaints.

Data from ER encounters in a teaching hospital for years 2019 and 2020 were extracted from an electronic database. The ICD-10-CM codes were used to assign the primary diagnosis. Joinpoint regression was applied to a time-series to detect changes in daily encounters (all-cause and MSK). Total number and median daily encounters were calculated by year, sex, age groups, and diagnostic codes for each year.

Overlapping intervals within March 2020 showed drops of 8.1 all-cause encounters per day (95% CI: 4.8-11.5), and 1.2 MSK encounters per day (95% CI: 0.8-1.7), resulting in net losses for the year of 33.2% for all-cause and 35.8% for MSK encounters. Reductions were observed for both sexes and all age groups. MSK codes with largest declines were low back pain, joint pain, and limb pain.

The COVID-19 pandemic resulted in major reductions in all-cause and MSK encounters in the ER of an academic hospital probably due to governmental restrictions and a change in patients behaviors. Persistence of the observed reduction suggests that patients requiring ER services delayed seeking care for MSK and other health conditions.

This article considers how health education organizations in the World Health Organization's 9 Vaccine Safety Network (VSN) use Twitter to communicate about vaccines with the public, and whether they answer questions and engage in conversations. Almost no research in public health, to our knowledge, has explored conversational structure on social media among posts sent by different accounts.

Starting with 1,017,176 tweets by relevant users, we constructed 2 corpuses of multi-tweet conversations. The first was 1,814 conversations that included VSN members directly, whereas the second was 2,283 conversations mentioning vaccines or vaccine denialism. The tweets and user metadata were then analyzed using an adaptation of rhetorical structure theory.

In the studied data, VSN members tweeted 12,677 times within conversations, compared to their 37,587 lone tweets. Their conversations were shorter than those in the comparison corpus (P < 0.0001), and they were involved in fewer multilogues (P < 0.0001).

While there is diversity among organizations, most were tied to the pre-social media broadcast model. In the future, they should try to converse more, rather than tweet more, and embrace best practices in risk communication.

The SARS-CoV-2 pandemic has highlighted the need for rapid creation and management of ICU field hospitals with effective remote monitoring which is dependent on the rapid deployment and integration of an Electronic Health Record (EHR). We describe the use of simulation to evaluate a rapidly scalable hub-and-spoke model for EHR deployment and monitoring using asynchronous training.

We adapted existing commercial EHR products to serve as the point of entry from a simulated hospital and a separate system for tele-ICU support and monitoring of the interfaced data. To train our users we created a modular video-based curriculum to facilitate asynchronous training. Effectiveness of the curriculum was assessed through completion of common ICU documentation tasks in a high-fidelity simulation. Additional endpoints include assessment of EHR navigation, user satisfaction (Net Promoter), system usability (System Usability Scale-SUS), and cognitive load (NASA-TLX).

A total of 5 participants achieved a 100% task completion on all domains except ventilator data (91%). Systems demonstrated high degrees of satisfaction (Net Promoter = 65.2), acceptable usability (SUS = 66.5), and acceptable cognitive load (NASA-TLX = 41.5); with higher levels of cognitive load correlating with the number of screens employed.

Clinical usability of a comprehensive and rapidly deployable EHR was acceptable in an intensive care simulation which was preceded by < 1 hour of video education about the EHR. This model should be considered in plans for integrated clinical response with remote and accessory facilities.

Describe the lived experience of a grassroots, nongovernmental disaster medical team (DMT) through a research lens and share practical lessons learned based on the DMT’s experience to support and inform future response teams.

Forty-five days after Hurricane Maria, a nongovernmental DMT provided primary medical care by means of community-based pop-up clinics and home visitations in 5 different areas of Puerto Rico. Observational data, photo images, and debriefing notes were collected and documented in the response team’s daily activity log. Field notes were coded using a descriptive coding method and then categorized into 2 domains specific to public health and medical diagnosis.

Medical aid was provided to nearly 300 (N = 296) residents. Field note observations identified exhaustion related to living conditions and the exacerbation of underlying conditions, such as reactive airway diseases, diabetes, hypertension, and depression due to the compounding effects of multiple post-disaster triggers. During home visitations, feelings of sadness and helplessness were identified secondary to natural disaster trauma and current living conditions.

Our nongovernmental DMT displayed similar characteristics demonstrated by federal DMTs post-natural disaster. Several strategic lessons learned emerged from the public health intervention important to future nongovernmental DMTs.

This risk assessment aims to investigate the analysis of cascading disaster risks from the perspective of the chemical industry and public health subsequent to the Kakhovka dam bombing in Ukraine.

The study utilized a modified observational cross-sectional risk assessment method to assess disaster risk. The method involved identifying the location of chemical factories, determining flooded or at-risk factories, analyzing the type and frequency of chemical hazards, assessing population exposure, and plotting a disaster risk metric. Data on chemical industries and flood extent were collected from open-source secondary data.

The destruction of the Kakhovka dam in June 2023 led to severe flooding, placing 42 000 individuals at risk. The analysis identified four chemical factories, with 1 affected by flooding and 3 at risk. The overall risk assessment indicated a high likelihood and severe consequences, including loss of life, environmental contamination, and property damage.

The combination of complex emergencies and high-risk chemical facilities in Kherson Oblast poses a significant risk of a chemical industry disaster. The interplay between compound and cascading risks during complex emergencies amid the current war further exacerbates the situation, leading to the devastation and destruction of the environment to the detriment of life, and aligns with the characterization of ecocide.

This study describes the progress that the World Health Organization (WHO) African (AFRO) region has made in establishing National Emergency Medical Teams (N-EMTs), the coordination mechanisms of the EMTs, and the regional training centers.

It used a retrospective descriptive analysis of the formulation and implementation of the EMTs Initiative from an insider perspective. The analysis is based on the review of available documents such as EMTs mission reports, assessments, surveys, EMT monthly bulletins, and meeting minutes in addition to key informant interviews (n = 5) with the EMT teams’ members to validate the findings and share field experiences.

The emergence of coronavirus disease 2019 (COVID-19) acted as an accelerator for the implementation of the EMT initiative in the AFRO region. A total of 18 EMT deployments were carried out in 16 countries in the AFRO region through the WHO EMT-network during COVID-19, providing support to countries in managing severe and critical COVID-19 cases.

A Regional Training Center for N-EMTs is being set up in Addis Ababa to train the N-EMTs and strengthen local capacity of health personnel in the region. Challenges include unavailability of mentors to support countries in implementing N-EMTs and the Regional Simulation Training Center, poor funding, and coordination in the rolling out of the N-EMTs.

Chemical-biological-radio-nuclear (CBRN) gas masks are the standard means for protecting the general population from inhalation of toxic industrial compounds (TICs), for example after industrial accidents or terrorist attacks. However, such gas masks would not protect patients on home mechanical ventilation, as ventilator airflow would bypass the CBRN filter. We therefore evaluated in vivo the safety of adding a standard-issue CBRN filter to the air-outflow port of a home ventilator, as a method for providing TIC protection to such patients.

Eight adult patients were included in the study. All had been on stable, chronic ventilation via a tracheostomy for at least 3 months before the study. Each patient was ventilated for a period of 1 hour with a standard-issue CBRN filter canister attached to the air-outflow port of their ventilator. Physiological and airflow measurements were made before, during, and after using the filter, and the patients reported their subjective sensation of ventilation continuously during the trial.

For all patients, and throughout the entire study, no deterioration in any of the measured physiological parameters and no changes in measured airflow parameters were detected. All patients felt no subjective difference in the sensation of ventilation with the CBRN filter canister in situ, as compared with ventilation without it. This was true even for those patients who were breathing spontaneously and thus activating the ventilator’s trigger/sensitivity function. No technical malfunctions of the ventilators occurred after addition of the CBRN filter canister to the air-outflow ports of the ventilators.

A CBRN filter canister can be added to the air-outflow port of chronically ventilated patients, without causing an objective or subjective deterioration in the quality of the patients’ mechanical ventilation. (Disaster Med Public Health Preparedness. 2018;12:739-743)

The objective of this work was to study mortality increase in Spain during the first and second academic semesters of 2020, coinciding with the first 2 waves of the Covid-19 pandemic; by sex, age, and education.

An observational study was carried out, using linked populations and deaths’ data from 2017 to 2020. The mortality rates from all causes and leading causes other than Covid-19 during each semester of 2020, compared to the 2017–2019 averages for the same semester, was also estimated. Mortality rate ratios (MRR) and differences were used for comparison.

All-cause mortality rates increased in 2020 compared to pre-covid, except among working-age, (25–64 years) highly-educated women. Such increases were larger in lower-educated people between the working age range, in both 2020 semesters, but not at other ages. In the elderly, the MMR in the first semester in women and men were respectively, 1.14, and 1.25 among lower-educated people, and 1.28 and 1.23 among highly-educated people. In the second semester, the MMR were 1.12 in both sexes among lower-educated people and 1.13 in women and 1.16 in men among highly-educated people.

Lower-educated people within working age and highly-educated people at older ages showed the greatest increase in all-cause mortality in 2020, compared to the pre-pandemic period.

The study aimed to determine the level of knowledge and perceptions of preparedness for disasters among nurses working in a tertiary university hospital.

The population of this cross-sectional study consisted of nurses working in a university hospital in the Eastern Black Sea Region of Turkey (n = 340). The sample included 183 nurses who were determined using the OpenEpi program and the universal sampling method. The data were collected using the Sociodemographic Information Form and the Disaster Preparedness Perception Scale in Nurses (DPPSN) and analyzed using SPSS 22 software.

The mean age of the participants was 34.31 + 8.52 years; 83.1% were female, 66.1% had at least a bachelor’s degree and worked in a surgical ward, 49.7% had been working for at least 11 years, and 58.5% had received training on disasters. Those who received disaster-related training received it mostly face to face (70.1%) from their institutions (91.6%) and in the form of 2–4 hours of training (75.7%); 52.5% had previously participated in a disaster-related drill, and 83.1% took on the role of caregiver during a disaster. The DPPSN mean score of the nurses involved in the study was found to be 3.53 ± 0.58 out of 5 points for the total scale.

The results of the study showed that nurses considered themselves partially adequate for disaster preparedness, in general.

Disasters may have major impacts to mental health and to the utilization of mental health services (MHS). Moreover, these effects may be worsened by the preclusion of access to basic services following the event. The aim of this study is to evaluate the utilization of public MHS by the population that suffered water supply interruption following the Mariana Dam Failure in Brazil, 2015.

We conducted an Interrupted Time Series analyzing secondary health data from the municipalities that faced water supply interruption, comparing it to data from the other municipalities of Minas Gerais state.

We found a higher immediate (RR: 1.78; 95% CI: 1.25–2.53) and gradual (RR: 1.05; 95% CI: 1.03–1.06) change in the rate of mental health visits (MHV) in the affected population following the event, whereas there was an immediate fall (RR: 0.41; 95% CI: 0.29–0.59) followed by a higher gradual increase (RR: 1.04; 95% CI: 1.02–1.06) in the rate of hospital admissions (HA) in the affected population.

The results suggest that there was an increase in the utilization of public MHS by the population that suffered water supply interruption following the disaster.

The emergence of the COVID-19 pandemic has had significant impact on human lives as well as economic and social stability. The United States has a complicated history with biosecurity as policy making, biodefense activities, and government transparency have historically been in contention. The terror attacks of September 11, 2001 uncovered various weaknesses in the national public health infrastructure that have persisted into the current pandemic.

This study explores the biodefense and public health preparedness landscape for trends in federal support and capacity building. It also investigates the applicability of public health emergency management principles to the biodefense structure. A mixed method was utilized in this study to investigate the qualitative and quantitative factors of the research inquiry. Braun and Clarke’s six phase framework for thematic analysis will assist with defining the important information from a review of the literature. The concurrent triangulation design permits that use of qualitative and quantitative data to more accurately define and analyze the relationship among the variables of interest

The results included the identification of 8 common themes of failure during the COVID-19 response: (1) accountable leadership, (2) statutory authorities and policies, (3) inter-agency coordination, (4) coherent data system for situational awareness, (5) strategic national stockpile and supply chain, (6) testing and surveillance, (7) health care system surge capacity and resilience, and (8) federal funds and the role of public health emergency management in the evolving landscape of biothreats, both intentional and natural.

To counter the increasing biothreats, the United States must invest in revamping the biodefense infrastructure to mimic and support public health emergency preparedness initiatives which will increase our resilience to various biothreats.

This project aimed to quantify and compare Massachusetts and Georgia public school districts’ 2017–2018 winter-storm-related Twitter unplanned school closure announcements (USCA).

Public school district Twitter handles and National Center for Education Statistics data were obtained for Georgia and Massachusetts. Tweets were retrieved using Twitter application programming interface. Descriptive statistics and regression analyses were conducted to compare the rates of winter-storm-related USCA.

Massachusetts had more winter storms than Georgia during the 2017–2018 winter season, but Massachusetts school districts posted winter-storm-related USCA at a 60% lower rate per affected day (adjusted rate ratio, aRR = 0.40, 95% confidence intervals, CI: 0.30, 0.52) than Georgia school districts after controlling for the student enrollments and Twitter followers count per Twitter account. A 10-fold increase in followers count was correlated with a 118% increase in USCA rate per affected day (aRR = 2.18; 95% CI: 1.74, 2.75). Georgia school districts had a higher average USCA tweet rate per winter-storm-affected day than Massachusetts school districts. A higher number of Twitter followers was associated with a higher number of USCA tweets per winter-storm-affected day.

Twitter accounts of school districts in Massachusetts had a lower tweet rate for USCA per winter-storm-affected days than those in Georgia.

Economic evaluation approaches are needed to establish useful interventions for saving lives, preventing economic damage, and saving recovery costs at the time of disasters. Thus, the present study is aimed to identify the studies that applied economic evaluation approaches/methods for evaluating the economic costs of disasters.

A scoping review was conducted to find the eligible studies and perform a comprehensive data analysis.

Based on the findings, cost-effectiveness analysis, economic loss assessment, modeling, or mapping, as well as behavioral economic analysis were used as the economic evaluation approaches/methods.

Applying economic evaluation approaches to illustrate the economic costs of disasters is highly recommended. Managing competing priorities and optimizing resources allocations to the most cost-effective interventions can be achieved by cost-effectiveness analysis. The results of economic loss assessment can be used as the basis of disaster preparedness and response planning. Economic modeling can be applied to compare different interventions and anticipate socio-economic effects of disasters. A behavioral economic approach can be effective for decision-making in the field of disaster health management. Further research is needed to identify the advantages and limitations of each economic evaluation method/approach in the field of health in disasters. Such research can preferably be designed as the systematic review and meta-analysis.

The University of Minnesota Crisis Humanitarian Simulation provides trans-disciplinary training in disaster response. The course directors wished to better understand the learning outcomes and experiences of simulation participants.

The learning outcomes and experiences of participants in the 2019 simulation were assessed using 3 modalities: 1) pre-and post-simulation test, 2) participants’ self-assessment of learning, and 3) qualitative feedback via an anonymous evaluation.

Participant scores on the knowledge survey were significantly higher after the simulation than before the simulation (mean percent correct 71% vs. 48%, P < 0.0001). A significant majority of participants who completed the assessment believed they had main gains within each learning objective. Anonymous evaluations contained both positive feedback and constructive criticism leading to plans for refinements in subsequent training events.

The Humanitarian Crisis Simulation is an effective experiential training program that increases participants’ knowledge in the field of disaster response. Participants also believed they had made gains in each learning objective. The authors’ analysis of elements that have contributed to the success of the program and areas for future program growth and improvement are discussed.