Promoted as a means of fueling markets and encouraging economic growth or recovery, cash transfers have become a popular approach to international assistance. The literature recognizes potential problems such as insecurity, corruption, misuse, gender inequality, market inflation, and ineffective targeting. We carried out population and beneficiary surveys in 1997 to evaluate the targeting of cash transfers in Bosnia soon after the end of the conflict.

The population survey visited a random sample of clusters from population registers in Bosnia and Herzegovina (BiH) and Republika Srpska (RS). A directly administered questionnaire asked households whether they received any cash handouts from the Municipal Welfare Office in the last year, and, if so, for what purpose, the amount, and how they used the money. We calculated coverage and inclusion and exclusion errors of the program. The field team also identified cash transfers beneficiaries from official lists of the program and attempted to contact a random sample of them to ask about their experience.

It was not possible to confirm receipts of cash in one third of the sample of 840 named beneficiaries; 19% could not be traced and 17% of those found denied receiving any cash. In the general population survey of 7182 households, coverage rates with cash assistance (11% in BiH, 3% in RS) were at least 44% lower than those declared by the distribution agencies, with considerable variation between cantons. Exclusion errors were high: 83% of those eligible according to the program's income criterion did not receive any cash. Although sufficient cash was dispensed to reach every United Nations High Commission for Refugees priority 1 (most needy) household, only 13% of these households (278/2125) admitted receiving any cash. Inclusion errors were also high: 60% of all of those who received cash were not in the priority 1 category and 46% were not eligible according to the program's income criterion. Extrapolating from the population survey findings, we could only account for a maximum of US$4 million received by households in BiH and RS up to May 1997, of the US$16 million dispersed by the program up to that time.

Targeting of the cash transfers program was poor, with large inclusion and exclusion errors. Much of the disbursed cash apparently did not reach the intended beneficiaries and could not be accounted for. Agencies on the ground did not have the necessary skills to handle the disbursements or to train national organizations to do so. (Disaster Med Public Health Prepardness. 2013;7:232-240)

We examined the association between disaster exposure, community support, and mental health outcomes in urban and nonurban participants of Galveston and Chambers counties after Hurricane Ike. The moderating effect of community support was evaluated as a protective factor relative to postdisaster mental health.

A representative population-based sample of 157 urban and 714 nonurban adults were interviewed 12 to 17 months after the hurricane about their mental health functioning, disaster exposure, and perceptions of community support.

A series of multiple regressions demonstrated that disaster exposure was associated with mental health outcomes for both groups. The strength of the association varied across population samples.Community support moderated the association between interpersonal effects of the disaster and posttraumatic stress disorder (PTSD) and depression outcomes in nonurban participants and the association between property damage and PTSD in urban participants.

Community support played a larger role in reducing PTSD and depression symptoms associated with the interpersonal effects of a disaster in the nonurban sample only. Communities may play a more beneficial role in the recovery process in nonurban areas that have elevated levels of injury or death attributed to a disaster. (Disaster Med Public Health Preparedness. 2013;0:1–9)

To identify the most and least commonly cited security management messages that nongovernmental organizations (NGOs) are communicating to their field staff, to determine the types of documentation that NGOs most often use to communicate key security messages, and to distinguish the points of commonality and divergence across organizations in the content of key security messages.

The authors undertook a systematic review of available security policies, manuals, and training materials from 20 international humanitarian NGOs using the InterAction Minimum Operating Security Standards as the basis for a review framework.

The most commonly cited standards include analytical security issues such as threat and risk assessment processes and guidance on acceptance, protection, and deterrence approaches. Among the least commonly cited standards were considering security threats to national staff during staffing decision processes, incorporating security awareness into job descriptions, and ensuring that national staff security issues are addressed in trainings. NGO staff receive security-related messages through multiple document types, but only 12 of the 20 organizations have a distinct security policy document. Points of convergence across organizations in the content of commonly cited standards were found in many areas, but differences in security risk and threat assessment guidance may undermine communication between aid workers about changes in local security environments.

Although the humanitarian community has experienced significant progress in the development of practical staff security guidance during the past 10 years, gaps remain that can hinder efforts to garner needed resources, clarify security responsibilities, and ensure that the distinct needs of national staff are recognized and addressed. (Disaster Med Public Health Preparedness. 2013;7:241-250)

To evaluate key attributes, strengths, and limitations of the American Red Cross (ARC) disaster-related mortality surveillance system implemented during Hurricane Ike in Texas 2008, and to provide recommendations for system improvement.

We evaluated key attributes of the ARC mortality surveillance system. Evaluation included interviews with stakeholders and linking ARC data with the Texas Department of State Health Services’ (DSHS) system for comparison.

During September 11 through October 6, 2008, the ARC identified 38 deaths, whereas DSHS identified 74 deaths related to Hurricane Ike (sensitivity = 47%; positive predictive value = 92%). The ARC had complete data on 61% to 92% of deaths, and an 83% to 97% concordance was observed between the 2 systems for key variables.

The ARC surveillance system is simple, flexible, and stable. We recommend establishing written guidelines to improve data quality and representativeness. As an important supporting agency in disaster situations and the sole source of data regarding disaster-related mortality in multiple states, improvement of the ARC system will benefit stakeholders and promote dissemination of useful information for preventing future deaths. (Disaster Med Public Health Preparedness. 2013;7:13-19)

To assess the prevalence of traumatic stress experienced by secondary responders to disaster events to determine if mental health education should be included in HAZWOPER training.

Preexisting survey tools for assessing posttraumatic stress disorder (PTSD), resiliency, and mental distress were combined to form a web-based survey tool that was distributed to individuals functioning in secondary response roles. Data were analyzed using the Fisher exact test, 1-way ANOVA, and 1-sample t tests.

Respondents reported elevated PTSD levels (32.9%) as compared to the general population. HAZWOPER-trained responders with disaster work experience were more likely to be classified as PTSD positive as compared to untrained, inexperienced responders and those possessing only training or experience. A majority (68.75%) scored below the mean resiliency level of 80.4 on the Connor-Davidson Resilience Scale. Respondents with only training or both training and experience were more likely to exhibit lower resiliency scores than those with no training or experience. PTSD positivity correlated with disaster experience. Among respondents, 91% indicated support for mental health education.

Given the results of the survey, consideration should be given to the inclusion of pre- and postdeployment mental health education in the HAZWOPER training regimen. (Disaster Med Public Health Preparedness. 2013;0:1-9)

Psychological assessment after disasters determines which survivors are acutely distressed or medically compromised and what kind of assistance is needed (whether practical or psychological). A mental health triage tool can help direct more people to the appropriate type of help. The purpose of this study was to determine the effectiveness of the Fast Mental Health Triage Tool (FMHT) and the Alsept-Price Mental Health Scale (APMHS) among public health workers and Medical Reserve Corps (MRC) volunteers in conducting mental health triage. Both tools screen for ability to follow simple commands, chronic medical conditions, mental health conditions and services, occult injuries, and traumatic events in the past year. Both were designed for use in disasters where mental health resources are scarce and survivors are already medically triaged.

Volunteers (n = 204) and workers (n = 66) were randomized into 3 groups, with 79 participating. Fifty-nine raters completed 20 each of 1180 mental health clinical vignettes of disaster survivors.

The survey presenting the vignettes was highly reliable at 0.771; the study model was parallel between baseline and treatment; and the interclass correlation among the raters was high at 0.852. Each rater triaged the same cases, but the rater was randomly assigned to use FMHT, APMHS, or no tool or scale. Between-subject effect for the tools used was significant (P = .039). The FMHT was significantly better than no tool in correct mental health triage, 67.3% to 51.5% (P = .028).

The incorporation of a temporal component should be evaluated for potential inclusion in existing mental health triage systems. (Disaster Med Public Health Preparedness. 2013;7:20-28)

To clarify advance measures for business continuity taken by disaster base hospitals involved in the Great East Japan Earthquake.

The predisaster situation regarding stockpiles was abstracted from a 2010 survey. Timing of electricity and water restoration and sufficiency of supplies to continue operations were investigated through materials from Miyagi Prefecture disaster medicine headquarters (prefectural medical headquarters) and disaster base hospitals (14 hospitals) in Miyagi Prefecture after the East Japan earthquake.

The number of hospitals with less than 1 day of stockpiles in reserve before the disaster was 7 (50%) for electricity supplies, 8 (57.1%) for water, 6 (42.9%) for medical goods, and 6 (42.9%) for food. After the disaster, restoration of electricity and water did not occur until the second day or later at 8 of 13 (61.5%) hospitals, respectively. By the fourth postdisaster day, 14 hospitals had requested supplies from the prefectural medical headquarters: 9 (64.3%) for electricity supplies, 2 (14.3%) for water trucks, 9 (64.3%) for medical goods, and 6 (42.9%) for food.

The lack of supplies needed to continue operations in disaster base hospitals following the disaster clearly indicated that current business continuity plans require revision. (Disaster Med Public Health Preparedness. 2013;0:1-6)

Following a sudden-onset disaster (SOD), rapid information is needed. We assessed the relevance of information available for relief planning on a main Internet portal following a major SOD.

We reviewed all information posted on the Reliefweb Web site in the first 7 days following the 2005 South Asian earthquake using a predeveloped registration form focusing on essential indicators. These data were compared with Pakistani government figures posted by the Centre for Research on the Epidemiology of Disasters.

A total of 820 reports were reviewed. More reports came from nongovernmental organizations (NGOs; 35%) than any other source. A total of 42% of reports addressed only national level information, while 32% specified information at the provincial level. Fewer than 12% of all reports discussed the earthquake at the more local division and district levels. Only 13 reports provided pre-earthquake estimates of the number of people living in the affected areas. A third of all reports cited a common figure of 2.5 million made homeless. These were lower than official figures of 5 million homeless. A total of 43% reported on the estimated number of deaths. The estimated number peaked on day 4 at 40 000. All of these reports were lower than official data, which reported 73 000 deaths in total.

Early reports heavily underestimated the number of affected, homeless, injured, and dead. Many reports repeated information provided from previous unnamed sources rather than providing unique contributions from eyewitness reports or from contextual information based on previous work in the area. Better information on predisaster essential indicators should be available and used in combination with post-SOD information to better adapt humanitarian relief and funding according to needs. (Disaster Med Public Health Preparedness. 2013;7:251-256)

Although recent emergencies or disasters have underscored the vital role of nongovernmental (NGO) resources, they remain not well understood or leveraged. We intended to develop an assets framework that identifies relevant NGO resources for disaster preparedness and response that can be used to assess their availability at state and local levels.

We conducted a search of peer-reviewed publications to identify existing asset frameworks, and reviewed policy documents and gray literature to identify roles of NGOs in emergency preparedness, response, and recovery. A standardized data abstraction form was used to organize the results by NGO sector.

We organized NGO assets into 5 categories: competencies, money, infrastructure or equipment, services, relationships, and data for each of the 11 sectors designated by the Centers for Disease Control and Prevention in the 2011 preparedness capabilities.

Our findings showed that the capacity of each sector to capture data on each asset type needs strengthening so that data can be merged for just-in-time analysis to indicate where additional relief is needed. (Disaster Med Public Health Preparedness. 2013;0:1–6)

The USS George Washington (GW) and the USS Ronald Reagan (RR), 2 US Navy aircraft carriers, experienced almost simultaneous outbreaks of novel H1N1 influenza A in the summer of 2009. We compared the respective epidemic control measures taken and subsequent lessons learned.

Data were collated from both outbreaks to assess various elements including attack rate, isolation/quarantine protocols, and treatment methods. The respective duration of each outbreak was compared with survival curve analysis. The number of personnel affected in each outbreak was compared using χ2 analysis.

Differences were found in the protocols used on the 2 ships. The GW treated about two-thirds of the patients with oseltamivir through day 14 and quarantined all patients meeting case definition throughout the outbreak. Face masks were used throughout. The RR used oseltamivir and quarantined many fewer patients (through days 5 and 3, respectively). No face masks were used after day 5. The outbreaks were similar in duration (GW = 25 days, RR = 27 days, P = .38), but the RR had significantly more cases (n = 253 vs 142, P < .0001). A portion of each group had samples that were confirmed H1N1 by polymerase chain reaction.

GW's protocol, including aggressive oseltamivir treatment of two-thirds of the cases and quarantine throughout the duration decreased the overall number of personnel affected, likely reducing the overall control reproduction number. Both outbreaks were similar in duration. Even though the GW expended significantly more resources than the RR, if the 2009 pandemic H1N1 strain had been as clinically severe as the 1918 pandemic, a more stringent treatment protocol may have been the only way to prevent significant operational impact.(Disaster Med Public Health Preparedness. 2013;7:29-35)

Recent US disasters highlight the current imbalance between the high proportion of chronically ill Americans who depend on prescription medications and their lack of medication reserves for disaster preparedness. We examined barriers that Los Angeles County residents with chronic illness experience within the prescription drug procurement system to achieve recommended medication reserves.

A mixed methods design included evaluation of insurance pharmacy benefits, focus group interviews with patients, and key informant interviews with physicians, pharmacists, and insurers.

Most prescriptions are dispensed as 30-day units through retail pharmacies with refills available after 75% of use, leaving a monthly medication reserve of 7 days. For patients to acquire 14- to 30-day disaster medication reserves, health professionals interviewed supported 60- to 100-day dispensing units. Barriers included restrictive insurance benefits, patients’ resistance to mail order, and higher copay-ments. Physicians, pharmacists, and insurers also varied widely in their preparedness planning and collective mutual-aid plans, and most believed pharmacists had the primary responsibility for patients’ medication continuity during a disaster.

To strengthen prescription drug continuity in disasters, recommendations include the following: (1) creating flexible drug-dispensing policies to help patients build reserves, (2) training professionals to inform patients about disaster planning, and (3) building collaborative partnerships among system stakeholders. (Disaster Med Public Health Preparedness. 2013;7:257-265)

Numerous practice reports recommend roles pharmacists may adopt during disasters. This study examines the peer-reviewed literature for factors that explain the roles pharmacists assume in disasters and the differences in roles and disasters when stratified by time.

Quantitative content analysis was used to gather data consisting of words and phrases from peer-reviewed pharmacy literature regarding pharmacists’ roles in disasters. Negative binomial regression and Kruskal-Wallis nonparametric models were applied to the data.

Pharmacists’ roles in disasters have not changed significantly since the 1960s. Pharmaceutical supply remains their preferred role, while patient management and response integration roles decrease in context of common, geographically widespread disasters. Policy coordination roles, however, significantly increase in nuclear terrorism planning.

Pharmacists’ adoption of nonpharmaceutical supply roles may represent a problem of accepting a paradigm shift in nontraditional roles. Possible shortages of personnel in future disasters may change the pharmacists’ approach to disaster management. (Disaster Med Public Health Preparedness. 2013;7:563–572)