Two Category 5 storms, Hurricane Irma and Hurricane Maria, hit the U.S. Virgin Islands (USVI) within 13 days of each other in September 2017. These storms caused catastrophic damage across the territory, including widespread loss of power, destruction of homes, and devastation of critical infrastructure. During large scale disasters such as Hurricanes Irma and Maria, public health surveillance is an important tool to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The USVI Department of Health (DoH) partnered with shelter staff volunteers to monitor the health of the sheltered population and help guide response efforts.

Shelter volunteers collect data on the American Red Cross Aggregate Morbidity Report form that tallies the number of client visits at a shelter’s health services every 24 hours. Morbidity data were collected at all 5 shelters on St. Thomas and St. Croix between September and October 2017. This article describes the health surveillance data collected in response to Hurricanes Irma and Maria.

Following Hurricanes Irma and Maria, 1130 health-related client visits were reported, accounting for 1655 reasons for the visits (each client may have more than 1 reason for a single visit). Only 1 shelter reported data daily. Over half of visits (51.2%) were for health care management; 17.7% for acute illnesses, which include respiratory conditions, gastrointestinal symptoms, and pain; 14.6% for exacerbation of chronic disease; 9.8% for mental health; and 6.7% for injury. Shelter volunteers treated many clients within the shelters; however, reporting of the disposition (eg, referred to physician, pharmacist) was often missed (78.1%).

Shelter surveillance is an efficient means of quickly identifying and characterizing health issues and concerns in sheltered populations following disasters, allowing for the development of evidence-based strategies to address identified needs. When incorporated into broader surveillance strategies using multiple data sources, shelter data can enable disaster epidemiologists to paint a more comprehensive picture of community health, thereby planning and responding to health issues both within and outside of shelters. The findings from this report illustrated that managing chronic conditions presented a more notable resource demand than acute injuries and illnesses. Although there remains room for improvement because reporting was inconsistent throughout the response, the capacity of shelter staff to address the health needs of shelter residents and the ability to monitor the health needs in the sheltered population were critical resources for the USVI DoH overwhelmed by the disaster. (Disaster Med Public Health Preparedness. 2019;13:38-43)

Access to primary health care (PHC) is very important for refugees. The aim of this study was to illuminate lived experience of Afghan refugees in Iran regarding PHC delivery.

This qualitative study was conducted in 2016–2017 by using the content analysis technique. Data were collected through individual deep interviews with Afghan refugees who lived in Iran. The data were analyzed by using a method by Graneheim and Lundman.

Four main categories and 12 subcategories were emerged, including (1) challenges before PHC delivery: large number of children, high service cost, not having medical insurance, access to health centers, appointment to get services, simultaneity of breastfeeding, and pregnancy; (2) challenges during PHC delivery: understanding Iranian words, health care provider’s behavior, delay in getting service in PHC centers; (3) challenges after delivery PHC: referral patient, high costs of paraclinics; and (4) free and good services.

Our results showed that Afghan refugees have several challenges in every stage of PHC delivery. Awareness of such problems can help medical personnel improve delivery of service to Afghan refugees, as well as using trained Afghani nurses to serve the refugees.

Torrential rainfall and flooding from September 2-6, 2014 submerged >350 villages in Jammu and Kashmir state. We conducted rapid needs assessment in capital Srinagar from 27 September to 1 October to assess population health and safety needs.

Based on Community Assessment for Public Health Emergency Response (CASPER) methodology, we selected 7 households each from 30 census blocks using 2-stage cluster sampling. We collected information on demographics, needs, and illnesses using structured questionnaire.

Of the 210 households surveyed, an estimated 57% (CI: 41%-73%) reported significant damage, 50% (CI: 36%-63%) were evacuated, and 16% (CI: 10%-22%) reported injuries. Households lacked electricity (22%; CI: 8.8%-36%), tap water (13%; CI: 5%-21%), working toilets (11%; CI: 4%-19%), and adequate food supply (14%; CI: 8%-20%). Moreover, 55% (CI: 45%-64%) of households reported cough, cold, fever, rashes, or diarrhea; 68% (CI: 59%-77%) experienced agitation, anxiety, depression, or nightmares since the flooding. Of the households with a member on medicines for non-communicable diseases, 40% did not have a week’s supply. Restoring basic essentials (30%; CI: 22%-37%) and repairing houses (30%; CI: 19%-40%) were the most urgent needs expressed.

Floods damaged >1/2 of households in Srinagar, disrupting basic essentials, and causing mental trauma. These findings helped authorities prioritize assistance with psychological symptoms and availability of prescription medicines. (Disaster Med Public Health Preparedness. 2019;13:133–137)

Iran, in terms of disasters, is among the top 10 countries in the world. Therefore, timely coordination and provision of rescue, transport, and treatment services after disasters are of particular importance. This study aimed to investigate and provide a short report on the provision of rescue, transport, and treatment services after the 2017 earthquake in Kermanshah.

This was a review and a descriptive study conducted using the analysis of documents and news published on valid Iranian sites and reports of some service providers in 2017 after the earthquake in Kermanshah.

The most important strengths of post-earthquake services were the military force’s cooperation, people’s support, sending the popular aid and donations to earthquake areas, and the tremendous national support and religious sympathy among the people. Sending the popular aid and donations was such that they resulted in the blockage of communication routes, heavy traffic on the roads, and disrupted the relief and rescue efforts process. However, the most important weaknesses in the provision of services after this earthquake were the lack of preparedness of the government systems and the lack of orderly management for appropriate assistance and relief and, therefore, there was an inappropriate distribution of popular aid and donations among the earthquake victims.

Proper coordination and service delivery after unexpected events in Iran have a considerable distance to reaching the desired point. Unfortunately, similar problems had also occurred in other earthquakes such as the Bam and Rudbar earthquakes. The repetition of these problems indicates the authorities’ lack of readiness and commitment to troubleshoot weaknesses in their emergency response plan. Therefore, it is necessary for government officials to have more preparedness in all related affairs and aspects. (Disaster Med Public Health Preparedness. 2019;13:691–694)

The intent of this study was to determine whether there are differences in disaster preparedness between urban and rural community hospitals across New York State.

Descriptive and analytical cross-sectional survey study of 207 community hospitals; thirty-five questions evaluated 6 disaster preparedness elements: disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness.

Completed surveys were received from 48 urban hospitals and 32 rural hospitals.There were differences in disaster preparedness between urban and rural hospitals with respect to disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, and perception of disaster preparedness. No difference was identified between these hospitals with respect to disaster preparedness funding levels.

The results of this study provide an assessment of the current state of disaster preparedness in urban and rural community hospitals in New York. Differences in preparedness between the two settings may reflect differing priorities with respect to perceived threats, as well as opportunities for improvement that may require additional advocacy and legislation. (Disaster Med Public Health Preparedness. 2019;13:424-428)

Community characteristics, such as perceived collective efficacy, a measure of community strength, can affect mental health outcomes following disasters. We examined the association of perceived collective efficacy with posttraumatic stress disorder (PTSD) and frequent mental distress (14 or more mentally unhealthy days in the past month) following exposure to the 2004 and 2005 hurricane seasons.

Participants were 1486 Florida Department of Health workers who completed anonymous questionnaires that were distributed electronically 9 months after the 2005 hurricane season. Participant ages ranged from 20 to 79 years (mean, 48; SD, 10.7), and the majority were female (79%), white (75%), and currently married (64%). Fifty percent had a BA/BS degree or higher.

In 2 separate logistic regression models, each adjusted for individual sociodemographics, community socioeconomic characteristics, individual injury/damage, and community storm damage, lower perceived collective efficacy was significantly associated with a greater likelihood of having PTSD (OR, 0.93; 95% CI, 0.90-0.96), and lower collective efficacy was significantly associated with frequent mental distress (OR, 0.94; 95% CI, 0.92-0.96).

Programs enhancing community collective efficacy may be a significant part of prevention practices and possibly lead to a reduction in the rate of PTSD and persistent distress postdisaster. (Disaster Med Public Health Preparedness. 2019;13:44–52).

In 2010, South Africa (SA) hosted the Fédération Internationale de Football Association (FIFA) World Cup (soccer). Emergency Medical Services (EMS) used the SA mass gathering medicine (MGM) resource model to predict resource allocation. This study analyzed data from the World Cup and compared them with the resource allocation predicted by the SA mass gathering model.

Prospectively, data were collected from patient contacts at 9 venues across the Western Cape province of South Africa. Required resources were based on the number of patients seeking basic life support (BLS), intermediate life support (ILS), and advanced life support (ALS). Overall patient presentation rates (PPRs) and transport to hospital rates (TTHRs) were also calculated.

BLS services were required for 78.4% (n = 1279) of patients and were consistently overestimated using the SA mass gathering model. ILS services were required for 14.0% (n = 228), and ALS services were required for 3.1% (n = 51) of patients. Both ILS and ALS services, and TTHR were underestimated at smaller venues.

The MGM predictive model overestimated BLS requirements and inconsistently predicted ILS and ALS requirements. MGM resource models, which are heavily based on predicted attendance levels, have inherent limitations, which may be improved by using research-based outcomes.

Little is known about the preparedness of hospitals to care for pediatric patients during a major incident in Japan. This study assessed the disaster preparedness of a children’s hospital in Japan by using a disaster drill.

We performed a triage drill with all hospitalized patients. The triage tags and medical records were reviewed retrospectively. We determined the efficacy of triage education, the validity of the Simple Triage and Rapid Treatment (START) method for children, and the potential need for evacuation through the disaster drill.

This study highlights 3 important issues about the hospital’s preparedness. First, it is difficult to promote disaster education for staff who are not well trained on handling disasters. Second, the START method is suitable for children older than 5 years, but it has a high rate of over-triaging among younger children. Third, approximately 40% of patients who are coded as immediate may require transportation resources in a hospital evacuation.

Our findings suggest that disaster preparedness, such as educating hospital staff regarding disasters and establishing evacuation systems for a number of pediatric patients when a disaster happens, is essential for caring for hospitalized children during a mass casualty incident. (Disaster Med Public Health Preparedness. 2019;13:429-432)

Mine rescue teams bear a high risk of injury. To improve medical emergency preparedness and injury prevention, this work analyzed the causes and severity of mine rescue teams’ casualty incidents, the primary injuries, and the link between the causes and the occurrences of the casualty incidents.

A total of 81 cases from 1953 to 2013 were used to analyze the casualty incidents of mine rescue teams based on the frequency of accidents. A panel with 4 rescue experts was set up to ensure the accuracy of the analysis.

The 81 casualty incidents occurred in 7 types of rescue work and were due to 6 causes. Organizational and personal factors were the leading cause, followed by rescue skill and equipment factors. Problems with decision-making and command have gradually become the primary inducement of casualty incidents in recent years, with an average death toll reaching up to 6 to 7 people. The main injuries causing death to team members were blast injury, burns, poisoning, suffocation, blunt trauma, and overwork injury. Some of the injured died because of medical emergency response failure.

The construction of emergency medical teams and the preparedness of disaster medicine need to be improved to reduce the mortality of the injured team members. Actions according to the causes of casualty incidents should be adopted for injury prevention. (Disaster Med Public Health Preparedness. 2019;13:695–699)

The objective of the study was to research the basic seismic response capability (BSRC) of hospitals in Lima Metropolitana. A large number of wounded could be registered in case of an earthquake; therefore, operational hospitals are necessary to cure the injured. The study focused on the operational performance of the hospitals, autonomies of essential resources such as power, water, medical gases, and medicine, in addition to the availability of emergency communication system and ambulances.

Data by a probabilistic seismic risk analysis have been used to assess the operational level of the hospitals. Subsequently, availability of an essential resource has been combined with the immediately operational hospitals to evaluate the BSRC of the health facilities.

Forty-one of Lima’s hospitals have been analyzed for a seismic event with 72-100 years of a return period. Three hospitals (7.3%) were capable to work in a self-sufficient manner for 72 hours, another three (7.3%) for 24 hours, and one (2.4%) for 12 hours.

Results showed a low performance of the hospitals in case of an earthquake. The issue is due to the high seismic vulnerability of the existing structures. Given the importance of Lima city in Peru, structural and nonstructural retrofitting plans should be implemented to improve the preparedness of the health system in case of an emergency. (Disaster Med Public Health Preparedness. 2019;13:138–143)

Two category 5 storms hit the US Virgin Islands (USVI) within 13 days of each other in September 2017. This caused an almost complete loss of power and devastated critical infrastructure such as the hospitals and airports

The USVI Department of Health conducted 2 response Community Assessments for Public Health Emergency Response (CASPERs) in November 2017 and a recovery CASPER in February 2018. CASPER is a 2-stage cluster sampling method designed to provide household-based information about a community’s needs in a timely, inexpensive, and representative manner.

Almost 70% of homes were damaged or destroyed, 81.2% of homes still needed repair, and 10.4% of respondents felt their home was unsafe to live in approximately 5 months after the storms. Eighteen percent of individual respondents indicated that their mental health was “not good” for 14 or more days in the past month, a significant increase from 2016.

The CASPERs helped characterize the status and needs of residents after the devastating hurricanes and illustrate the evolving needs of the community and the progression of the recovery process. CASPER findings were shared with response and recovery partners to promote data-driven recovery efforts, improve the efficiency of the current response and recovery efforts, and strengthen emergency preparedness in USVI. (Disaster Med Public Health Preparedness. 2019;13:53-62)

The present study aimed to provide a comprehensive assessment of Swiss hospital disaster preparedness in 2016 compared with the 2006 data.

A questionnaire was addressed in 2016 to all heads responsible for Swiss emergency departments (EDs).

Of the 107 hospitals included, 83 (78%) returned the survey. Overall, 76 (92%) hospitals had a plan in case of a mass casualty incident, and 76 (93%) in case of an accident within the hospital itself. There was a lack in preparedness for specific situations: less than a third of hospitals had a specific plan for nuclear/radiological, biological, chemical, and burns (NRBC+B) patients: nuclear/radiological (14; 18%), biological (25; 31%), chemical (27; 34%), and burns (15; 49%), and 48 (61%) of EDs had a decontamination area. Less than a quarter of hospitals had specific plans for the most vulnerable populations during disasters, such as seniors (12; 15%) and children (19; 24%).

The rate of hospitals with a disaster plan has increased since 2006, reaching a level of 92%. The Swiss health care system remains vulnerable to specific threats like NRBC. The lack of national legislation and funds aimed at fostering hospitals’ preparedness to disasters may be the root cause to explain the vulnerability of Swiss hospitals regarding disaster medicine. (Disaster Med Public Health Preparedness. 2019;13:433-439)

To investigate the relative importance of 10 attributes identified in prior studies as essential for effective disaster medical responders and leaders.

Emergency and disaster medical response personnel (N=220) ranked 10 categories of disaster worker attributes in order of their importance in contributing to the effectiveness of disaster responders and leaders.

Attributes of disaster medical leaders and responders were rank ordered, and the rankings differed for leaders and responders. For leaders, problem-solving/decision-making and communication skills were the highest ranked, whereas teamwork/interpersonal skills and calm/cool were the highest ranked for responders.

The 10 previously identified attributes of effective disaster medical responders and leaders include personal characteristics and general skills in addition to knowledge of incident command and disaster medicine. The differences in rank orders of attributes for leaders and responders suggest that when applying these attributes in personnel recruitment, selection, and training, the proper emphasis and priority given to each attribute may vary by role. (Disaster Med Public Health Preparedness. 2019;13:700–703)

To assess the psychological impact of a mass casualty incident (MCI) in a subset of personnel in a level I hospital.

Emergency department staff responded to an MCI in June 2017 in Turin, Italy by an unexpected sudden surge of casualties following a stampede (mass escape). Participants completed the Psychological Simple Triage and Rapid Treatment Responder Self-Triage System (PsySTART-R), which classified the potential risk of psychological distress in “no risk” versus “at risk” categorization and identified a range of impacts aggregated for the population of medical responders. Participants were administered a questionnaire on the perceived effectiveness of management of the MCI. Two months later, the participants were evaluated using the Hospital Anxiety and Depression Scale (HADS), the Kessler Psychological Distress Scale (K6), and the Posttraumatic Stress Disorder Checklist (PCL-5).

The majority of the responders were classified as “no risk” by the PsySTART-R; no significant differences on HADS, K6, and PCL-5 were found in the participants grouped by the PsySTART-R categories. The personnel acquainted to work in emergency contexts (emergency department and intensive care unit) scored significantly lower in the HADS than the personnel usually working in other wards. The number of positive PsySTART-R criteria correlated with the HADS depression score.

Most of the adverse psychological implications of the MCI were well handled and averted by the responders. A possible explanation could be related to factors such as the clinical condition of the victims (most were not severely injured, no fatalities), the small number of casualties (87) brought to the hospital, the event not being considered life-threatening, and its brief duration, among others. Responders had mainly to cope with a sudden surge in casualties and with organizational issues.

Parents and children are vulnerable populations following hurricanes, and evacuation is an important safety strategy. Yet, little is known about “before the storm” stressors, particularly the surrounding evacuation, affecting families. Thus, following Hurricane Irma, we evaluated both stressful and positive aspects of the evacuation process for families, and we compared perceived safety and stress before, during, and after the hurricane across evacuating and non-evacuating families.

South Florida parents of children under age 18 years (N=554; 97% mothers) completed an online survey in the months following Hurricane Irma, assessing perceptions of stress, safety, and evacuation experiences. Quantitative data and open-ended responses were gathered.

Most families (82%) residing in mandatory evacuation zones evacuated, although many not in mandatory zones (46%) also evacuated. Parents who evacuated felt significantly safer during the storm, but more stressed before and during the storm, than non-evacuees. Evacuation-related travel and multiple family issues were rated as most stressful, although some positive aspects of evacuation were offered.

Findings have implications for emergency planners (eg, pre-/post-storm traffic flow needs, emotional needs of parents arriving at shelters) and for families (eg, importance of developing family disaster plans, controlling media exposure) to reduce evacuation stress for future storms. (Disaster Med Public Health Preparedness. 2019;13:63-73)

This study aimed to identify maritime transportation disruption impacts on available health care supplies and workers necessary to deliver hospital-based acute health care in geographically isolated communities post-disaster.

Semi-structured interviews were conducted with 25 key informants knowledgeable about the hospital-based acute health care supply chain and workforce emergency management plans and procedures in 2 coastal communities in British Columbia. These locations were accessed primarily through maritime transportation, including one urban center and one smaller, more remote community. Interview transcriptions were thematically analyzed.

Critical vulnerabilities to hospital-based acute health care delivery due to a maritime transportation disruption identified include lack of information about the existing supply chain, lack of formal plans and agreements, and limited local supply storage and workforce capacity. Measures to decrease vulnerability and enhance system capacity can be fostered to enhance acute health care system resilience for these and other geographically isolated communities.

A maritime transportation disruption has the potential to impact the availability of hospital-based health care supplies and health care personnel necessary to deliver acute health care in coastal communities post-disaster. Multisector engagement is required to address complex interdependencies and competing priorities in emergency response. Additional research and public-private collaboration is necessary to quantify potential impacts of maritime transportation disruption on the acute health care system. (Disaster Med Public Health Preparedness. 2019;13:440-448)

While carrying out a scoping review of earthquake response, we found that there is no universal standardized approach for assessing the quality of disaster evidence, much of which is variable or not peer reviewed. With the lack of a framework to ascertain the value and validity of this literature, there is a danger that valuable insights may be lost. We propose a theoretical framework that may, with further validation, address this gap.

Existing frameworks – quality of reporting of meta-analyses (QUORUM), meta-analysis of observational studies in epidemiology (MOOSE), the Cochrane assessment of bias, Critical Appraisal Skills Programme (CASP) checklists, strengthening the reporting of observation studies in epidemiology (STROBE), and consensus guidelines on reports of field interventions in disasters and emergencies (CONFIDE)–were analyzed to identify key domains of quality. Supporting statements, based on these existing frameworks were developed for each domain to form an overall theoretical framework of quality. This was piloted on a data set of publications from a separate scoping review.

Four domains of quality were identified: robustness, generalizability, added value, and ethics with 11 scored, supporting statements. Although 73 out of 111 papers (66%) scored below 70%, a sizeable portion (34%) scored higher.

Our theoretical framework presents, for debate and further validation, a method of assessing the quality of non-traditional studies and thus supporting the best available evidence approach to disaster response. (Disaster Med Public Health Preparedness. 2019;13:147–151)

The aim of this study was to (1) assess the long-term mental and behavioral health outcomes of the Deepwater Horizon Oil Spill of residents in the Gulf Coast and to (2) identify populations that may be particularly vulnerable to future disasters.

The Survey of Trauma, Resilience, and Opportunity in Neighborhoods in the Gulf (STRONG) is a population-representative sample of 2520 coastal residents surveyed in Texas, Louisiana, Alabama, Mississippi, and Florida in 2016. We present prevalence estimates for positive screens of depression, anxiety, and alcohol misuse, as well as receipt of health care services. We examine differences in these outcomes across states, affected occupational groups, and demographic groups.

Resource loss attributed to the spill was associated with positive screens for depression and anxiety. Almost 50% of adults screened positive for depression, anxiety, or alcohol misuse, but less than 20% of these currently access mental health care. Black residents were less likely to have health insurance and a usual source of care but were more likely to have visited the emergency room in the past 12 months.

Surveillance data from STRONG can help policy-makers and other stakeholders develop targeted approaches to foster resilience, particularly among vulnerable populations, and thereby mitigate the effects of future disasters.

Children are at increased risk for experiencing negative physical and mental health outcomes as a result of disasters. Millions of children spend their days in childcare centers or in residential family childcare settings. The purpose of this study was to describe childcare providers’ perceived levels of preparedness capabilities and to assess differences in levels of perceived preparedness between different types of childcare providers.

A national convenience sample of childcare center administrators and residential family childcare administrators completed a brief online survey about their preparedness efforts.

Overall, there were few differences in preparedness between childcare centers and residential family childcare providers. However, childcare centers were more likely to report that they had written plans (94.47%) than residential family childcare providers (83.73%) were (χ12=15.62; P<.001). Both types of providers were more likely to report being very prepared/prepared for fires (91.31%) than they were for any other type of emergency (flooding, active shooter, etc.; 45.08% to 79.34%).

Future work should assess how childcare providers respond to and recover from emergencies, as well as explore the types of resources childcare providers need in order to feel comfortable caring for children during such emergency situations. (Disaster Med Public Health Preparedness. 2019;13:704–708)