The increased risk of mass accidents or major catastrophes taking place necessitates the organization of remedial measures to help protect against these unusual events and adequate preparation in order to minimize their effects. One such initiative is the early notification of residents within a specific area about the risk of a particular calamity. Nowadays, the prevalence of mobile devices enables the installation of various mobile applications allowing for the communication and receiving of information about potential dangers. In many countries there are variously developed systems of notification in place based specifically on text messages.

Currently, new laws introduced in Poland establish that it is the obligation of operators of mobile networks to send text messages to all customers of these networks who are within the area where there is a serious risk of a catastrophe. Such messages are in the form of a short alert, to be sent only in extraordinary situations when there is an immediate threat to health or life. The alert is intended to help in the avoidance of danger or to mitigate its impact.

This article presents the potential implementation of the early warning system based on text message alerts in Poland, and in particular focuses on decreasing the risks associated with natural disasters.

While early text messaging is essential to disaster communications and mitigation, the article further states that means must be found to ensure equal access to the most vulnerable populations and all those, vulnerable and not, who do not have immediate access to text messaging systems. (Disaster Med Public Health Preparedness. 2019;13:709–712)

There has been little research on the health consequences of evacuation in the disaster context. A comparative analysis of survival between evacuated and nonevacuated hospital dialysis patients was conducted following Japan’s Fukushima Dai-ichi nuclear power plant incident, which occurred on March 11, 2011.

The study included 554 patients (mean age: 70.9) receiving dialysis therapy at one of the Tokiwakai Group hospitals—all of which are located in and around Iwaki City, approximately 50 km from the Fukushima nuclear plant—as of the incident date. The patients’ survival after the incident was tracked until March 3, 2017. Significant differences in mortality rates between postincident evacuees and nonevacuees were tested using the Bayesian survival analysis with Weibull multivariate regression.

Out of 554 dialysis patients, 418 (75.5%) were evacuated after the incident. The postincident mortality rate (adjusted for covariates) of evacuees was not statistically significantly different from that of nonevacuees. The hazard ratio was 1.17 (95% credible intervals: 0.77-1.74).

If performed in a well-planned manner with satisfactory arrangements for appropriate selection of evacuees and their transportation, evacuation could be a reasonable option, which might save more lives of vulnerable people.

The study aimed to examine impact of think-tanks designed to create policies for emerging threats on medical teams’ perceptions of individual and systemic emergency preparedness.

Multi-professional think-tanks were established to design policies for potential attacks on civilian communities. In total, 59 multi-sector health care managers participated in think-tanks focused on: (a) primary care services in risk zones; (b) hospital care; (c) casualty evacuation policies; (d) medical services to special-needs populations; and (e) services in a “temporary military-closed zone.” Participants rotated systematically between think-tanks. Perceived individual and systemic emergency preparedness was reviewed pre-post participation in think-tanks.

A significant increase in perceived emergency preparedness pre-post-think-tanks was found in 8/10 elements including in perceived individual role proficiency (3.71±0.67 vs 4.60±0.53, respectively; P<0.001) and confidence in colleagues’ proficiency during crisis (3.56±0.75 vs 4.37±0.61, respectively; P<0.001). Individual preparedness and role perception correlates with systemic preparedness and proficiency in risk assessment.

Participation in policy-making impacts on individuals’ perceptions of empowerment including trust in colleagues’ capacities, but does not increase confidence in a system’s preparedness. Field and managerial officials should be involved in policy-making processes, as a means to empower health care managers and improve interfaces and self-efficacy that are relevant to preparedness and response for crises. (Disaster Med Public Health Prepardness. 2019;13:152–157)

This paper reports on undergraduate health care students’ perception of societal vulnerability to disasters in the context of population aging. Forecast increases in extreme weather events are likely to have a particularly devastating effect on older members of the community.

Undergraduate paramedicine and nursing students were surveyed using the Perceptions of Ageing and Disaster Vulnerability Scale (PADVS) to determine their views on the risks posed to older members of the community by disasters. Data analysis included a comparison of subscales relating to isolation, health system readiness, declining function, and community inclusiveness.

Students reported a moderate level of concern about disaster vulnerability. Students who had previously completed another university degree reported significantly higher levels of concern than those without a prior degree. Australian students reported lower concern about societal vulnerability compared to a previously reported cohort of Japanese students.

Our study suggests current education of future health care students does not promote adequate levels of awareness of the health-related challenges posed by disasters, particularly among older members of the community. Without addressing this gap in education, the risk of negative outcomes for both unprepared first responders and older members of the community is significant. (Disaster Med Public Health Prep. 2019;13:449-455)

We aimed to investigate the association between types of housing and allergic symptoms at 3–4 years following the Great East Japan Earthquake.

Our study was based on the ToMMo Child Health Study conducted in 2014 and 2015, a cross-sectional survey of public school children in Miyagi Prefecture, Japan. Of the 46 648 invited schoolchildren in the 2nd to 8th grades, 9884 were included. Presence of eczema, wheezing, and mental health symptoms was defined with questionnaires. To calculate odds ratios (ORs) and 95% CIs for the associations between types of housing and eczema or respiratory symptoms, we fitted generalized linear mixed models, included a random effect for municipality of residence, and adjusted for sex, school grade, survey year, and mental health symptoms.

Prefabricated temporary housing was significantly associated with eczema symptoms (OR, 1.46; 95% CI, 1.06–2.02). Even after adjusting for the presence of mental health symptoms, our analysis produced similar results (OR, 1.42; 95% CI, 1.03–1.96). Conversely, it was not significantly associated with respiratory symptoms (OR, 0.97; 95% CI, 0.61–1.54).

Children living in prefabricated temporary housing had a higher prevalence of eczema symptoms; however, prevalence of respiratory symptoms was not significantly higher.

Despite efforts by civil defense authorities, levels of households’ preparedness to emergencies remain insufficient in many countries. Engaging the public in preparedness behavior is a challenge worldwide. The purpose of this study was to explore the efficacy of psychological intervention in promoting preparedness behavior to armed conflicts in Israel.

A randomized controlled trial (N = 381) with two control groups and three intervention groups was used. The psychological interventions studied were elevated threat perception, external reward, and manipulation of a cognitive cluster related to preparedness.

The results of the analysis suggest a significant effect of intervention on the increase of reported preparedness (F4,375 = 4.511, P = 0.001). The effect is attributed to the intervention group in which external reward was offered. Participants in this group were about two times more likely to report greater levels of preparedness compared to the control group (RR = 1.855; 95% CI: 1.065, 3.233).

The findings suggest that preparedness behavior can be promoted through external incentives. These are presumably effective motivators because they encourage preparedness while allowing subjects to retain their denial as an adaptive coping mechanism. Innovative thinking is required to overcome the psychological barriers associated with public reluctance to engage in preparedness. (Disaster Med Public Health Preparedness. 2018;13:713–723)

School-aged children are a risk group in terms of accidents and injuries, and these factors may be the primary causes of death in children. Teachers have important roles in preventing accidents and injuries and giving first aid. The purpose of this research was to identify situations in which teachers most frequently encounter the need to administer first aid to children and whether the teachers performed the correct application in these events.

This descriptive study was conducted with 331 teachers in a city in the Central Anatolia Region. The study was approved by the local ethics committee and the participants.

Of the 45.3% teachers educating children ages 6 to 15 years, 81.0% of the teachers were familiar with first aid, but only 23.0% claimed to have an adequate knowledge. In the previous year, situations that had required first aid included epistaxis (75.2%), abdominal pain (49.2%), and vomiting (39.2%). The study also investigated any accidents and injuries occurring, their causes, and the teachers’ interventions following the accidents and injuries. It was found that teachers had information about first aid, but they did not trust themselves enough to practice it.

Understanding the causes of accidents and injuries, finding preventive measures, and updating teachers’ knowledge about this subject are important to provide a safe educational environment. (Disaster Med Public Health Preparedness. 2019;13:456-462)

The aim of this study was the construction and validation of a novel research instrument to quantify the degree of post-hurricane trauma and distress in an affected population. The Post-Hurricane Distress Scale (PHDS) has quantitative measures of both acute and prolonged distress, attributable to meteorological and hydrological disasters.

A careful evaluation of existing questionnaires, as well as extensive canvasing of the post-Maria population of Puerto Rico, availed the construction of the PHDS. The PHDS consists of 20 items, organized into 4 subscales. The PHDS was pre-validated (n=79), revised, and then distributed to a broad sampling of the post-Hurricane Maria Puerto Rican population (n=597). Validation, including factor analysis, analyses of concurrent validity, discriminant validity, and internal reliability, was performed.

After comparing various scales, factor loading profiles, concurrent validities, and models of fit, we show that the PHDS is best scored as a single 0–6 distress scale. When compared with the Traumatic Exposure Severity Scale, the PHDS shows superior concurrent validity, more accurately predicting scores for the Peritraumatic Distress Inventory, Impact of Event Scale – Revised, and Generalized Anxiety Disorder 7 Scale. The PHDS shows good internal reliability and discriminant validity.

The PHDS represents a novel, useful instrument for disaster first-responders and researchers. The prompt identification of high-risk populations is possible using this instrument. (Disaster Med Public Health Preparedness. 2019;13:82-89)

One of the most important measures following disasters is setting up a communicable disease surveillance system (CDSS). This study aimed to develop indicators to assess the performance of CDSSs in disasters.

In this 3-phase study, firstly a qualitative study was conducted through in-depth, semistructured interviews with experts on health in disasters and emergencies, health services managers, and communicable diseases center specialists. The interviews were analyzed, and CDSS performance assessment (PA) indicators were extracted. The appropriateness of these indicators was examined through a questionnaire administered to experts and heads of communicable diseases departments of medical sciences universities. Finally, the designed indicators were weighted using the analytic hierarchy process approach and Expert Choice software.

In this study, 51 indicators were designed, of which 10 were related to the input (19.61%), 17 to the process (33.33%), 13 to the product (25.49%), and 11 to the outcome (21.57%). In weighting, the maximum score was that of input (49.1), and the scores of the process, product, and outcome were 31.4, 12.7, and 6.8, respectively.

Through 3 different phases, PA indicators for 4 phases of a chain of results were developed. The authors believe that these PA indicators can assess the system’s performance and its achievements in response to disasters. (Disaster Med Public Health Preparedness. 2019;13:158–164)

Disaster-related research funding in the United States has not been described. This study characterizes Federal funding for disaster-related research for 5 professional disciplines: medicine, public health, social science, engineering, emergency management.

An online key word search was performed using the website, www.USAspending.gov, to identify federal awards, grants, and contracts during 2011–2016. A panel of experts then reviewed each entry for inclusion.

The search identified 9145 entries, of which 262 (3%) met inclusion criteria. Over 6 years, the Federal Government awarded US $69 325 130 for all disaster-related research. Total funding levels quadrupled in the first 3 years and then halved in the last 3 years. Half of the funding was for engineering, 3 times higher than social sciences and emergency management and 5 times higher than public health and medicine. Ten (11%) institutions received 52% of all funding. The search returned entries for only 12 of the 35 pre-identified disaster-related capabilities; 6 of 12 capabilities appear to have received no funding for at least 2 years.

US federal funding for disaster-related research is limited and highly variable during 2011–2016. There are no clear reasons for apportionment. There appears to be an absence of prioritization. There does not appear to be a strategy for alignment of research with national disaster policies.

While the short-term effects of disasters on health care utilization are well documented, less is known regarding potential longer-term effects. This study investigates the effects of Hurricane Katrina on the health care utilization of older individuals with diabetes.

We examined Medicare claims and enrollment data for the 2002-2004 and 2006-2008 time periods for older individuals with diabetes. Our quasi-experimental design analyzed utilization across 2 treated and 3 control groups. We compared the proportion of individuals who received a screen related to diabetes before and after Katrina in the treated groups to the proportions in the control groups. Our regression analysis employs individual and year fixed effects to control for factors specific to a given individual or to a given year.

We found that utilization rates in the 2002-2004 period exhibited roughly parallel trends for the treated and control groups, which provides support for our research design. The 2006-2008 utilization rates were generally lower for the treated groups than they were for the control groups. The differences were especially pronounced for older age cohorts.

Our study suggests that the effects of disasters on health care utilization may persist for years after the event. Recovery efforts may be improved by addressing both short-term and long-term health care interruptions. (Disaster Med Public Health Preparedness. 2019;13:724–731)

Beta radiation from nuclear weapons fallout could pose a risk of cutaneous radiation injury (CRI) to evacuating populations but has been investigated only cursorily. This work examines 2 components of CRI necessary for estimating the potential public health consequences of exposure to fallout: dose protraction and depth of dose.

Dose protraction for dry and moist desquamation was examined by adapting the biological effective dose (BED) calculation to a hazard function calculation similar to those recommended by the National Council on Radiation Protection and Measurements for other acute radiation injuries. Depth of burn was examined using Monte Carlo neutral Particle version 5 to model the penetration of beta radiation from fallout to different skin tissues.

Nonlinear least squares analysis of the BED calculation estimated the hazard function parameter θ1 (dose rate effectiveness factors) as 25.5 and 74.5 (Gy-eq)2 h−1 for dry and moist desquamation, respectively. Depth of dose models revealed that beta radiation is primarily absorbed in the dead skin layers and basal layer and that dose to underlying tissues is small (<5% of dose to basal layer).

The low relative dose to tissues below the basal layer suggests that radiation-induced necrosis or deep skin burns are unlikely from direct skin contamination with fallout. These results enable future modeling studies to better examine CRI risk and facilitate effectively managing and treating populations with specialized injuries from a nuclear detonation. (Disaster Med Public Health Preparedness. 2019;13:463-469)

The aim of this study was to analyze retrospectively the earthquake-induced injuries caused by the October 2015 Hindu Kush earthquake in Pakistan. This is the first population-based study to assess epidemiologically earthquake-induced injuries in the Hindu Kush region, one of the world’s most mountainous and seismically active regions. Unfortunately, only limited studies have investigated the earthquake-induced injuries and deaths in the region epidemiologically.

The 5 worst affected districts were selected according to the highest number of deaths and injuries recorded. A total of 1,790 injuries and 232 deaths were reported after the 2015 earthquake. In our study area, 391 persons were recorded and verified to have been injured as a result of the earthquake. We attempted to investigate all of the 391 injured people, but the final study looked at 346 subjects because the remaining 45 subjects could not be traced because of the non-availability of their complete records and their refusal to participate in the study.

Using the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD 10), we found that the highest number – 20.23% (70 of 346) – of injuries in the earthquake fall in the class of “Injuries to an unspecified part of trunk, limb, or body region (T08-T14).” The class of “Injuries to knee and lower leg (S80-S89),” which count 15.61% (54 out of 346), followed it, and “Injuries involving multiple body regions (T00-T07)” were making 14.74% of total injuries (51 out of 346).

In times of natural disasters like earthquakes, collecting and analyzing real-time data can be challenging. Therefore, a retrospective data analysis of deaths and injuries induced by the earthquake is of high importance. Studies in these emerging domains will be crucial to initiate health policy debates and to prevent and mitigate future injuries and deaths. (Disaster Med Public Health Preparedness. 2018;13:732–739).

This study explores the impact of economic hazard areas on hospital-based emergency departments to determine whether economically hazardous environments, characterized by the change of population, income per capita, and unemployment rate, experience a higher number of emergency room visits than areas of lower rated economic hazard risk in the United States.

A cross-sectional design was used of a nationally constructed data set of hospital-based emergency departments of over 6,000 hospitals in the United States. We identified our quality outcome measure as the emergency room visits rate within a hospital service area. We created the variable by dividing the number of emergency room visits by the population of the hospital services area in which the emergency room was located.

Results indicate that there is a difference in the incident rate ratio of emergency room visits between environments considered to be experiencing greater amounts of hazard, compared to lower amounts of hazard.

Hospital administrators and health policy-makers need to work in conjunction to focus efforts on public safety as a key objective in the delivery of emergency medical care. One crucial effort that hospital administrators need to focus on is improving emergency room capacity and efficiency as part of the disaster preparedness plan (Disaster Med Public Health Prep. 2019;13:470-475)

The objective of this study is to characterize US-based disaster training courses available to disaster response and disaster health professionals. Its purpose is to better inform policies and decision-making regarding workforce and professional development to improve performance.

Courses were identified from 4 inventories of courses: (1) National Library of Medicine Disaster Lit database; (2) TRAIN National Learning Network; (3) Federal Emergency Management Agency (FEMA) National Preparedness Course Catalog; and (4) Preparedness and Emergency Response Learning Centers. An online search used 30 disaster-related key words. Data included the course title, description, target audience, and delivery modality. Levels of learning, target capability, and function were categorized by 3 expert reviewers. Descriptive statistics were used.

There were 3662 trainings: 2380 (65%) for professionals (53% for public health); 83% of the courses were distance learning, with 16% via classroom. Half of all trainings focused on 3 of 37 disaster capabilities and 38% of them were related to chemical, biological, radiological, nuclear, and explosives (CBRNE). The educational approach was knowledge-based for all courses and 99.6% imparted only lower levels of learning.

Despite thousands of courses available, there remain significant gaps in target audience, subject matter content, educational approaches, and delivery modalities, particularly for health and public health professionals.

To determine whether there were incremental mental health impacts, specifically on depression trajectories, as a result of the 2008 economic crisis (the Great Recession) and subsequent Hurricane Sandy.

Using latent growth mixture modeling and the ORANJ BOWL dataset, we examined prospective trajectories of depression among older adults (mean age, 60.67; SD, 6.86) who were exposed to the 2 events. We also collected community economic and criminal justice data to examine their impact upon depression trajectories. Participants (N=1172) were assessed at 3 times for affect, successful aging, and symptoms of depression. We additionally assessed posttraumatic stress disorder (PTSD) symptomology after Hurricane Sandy.

We identified 3 prospective trajectories of depression. The majority (83.6%) had no significant change in depression from before to after these events (resilience), while 7.2% of the sample increased in depression incrementally after each event (incremental depression). A third group (9.2%) went from high to low depression symptomology following the 2 events (depressive-improving). Only those in the incremental depression group had significant PTSD symptoms following Hurricane Sandy.

We identified a small group of individuals for whom the experience of multiple stressful events had an incremental negative effect on mental health outcomes. These results highlight the importance of understanding the perseveration of depression symptomology from one event to another. (Disaster Med Public Health Preparedness. 2019;13:173–182)

The Florida Department of Health in Miami-Dade County (DOH-Miami-Dade) investigated 106 reported carbon monoxide (CO) exposures over a 9-day timeframe after Hurricane Irma. This report evaluates risk factors for CO poisoning and the importance of heightened surveillance following natural disasters.

Data on CO poisoning cases from September 9 to 18, 2017 were extracted from Merlin, the Florida Department of Health Surveillance System. Medical records were obtained and follow-up interviews were conducted to collect data on the confirmed CO poisoning cases. Data were analyzed using SAS v9.4.

Ninety-one of the 106 people exposed to CO met the case definition for CO poisoning: 64 confirmed, 7 probable, and 20 suspect cases. Eighty-eight percent of the affected individuals were evaluated in emergency departments and 11.7% received hyperbaric oxygen treatment. The most frequently reported symptoms included headache (53.3%), dizziness (50.7%), and nausea (46.7%). Three patients expired due to their exposure to CO.

Post Hurricane Irma, the DOH-Miami-Dade investigated numerous cases for CO exposure. By understanding who is most likely to be impacted by CO and the impact of generators’ location on people’s health, education efforts can be tailored to the population most at risk and further CO exposures and related mortalities following natural disasters can be reduced. (Disaster Med Public Health Preparedness. 2019;13:94–96)