To analyze the development of disaster medicine and to identify the main obstacles to improving disaster medicine research and application.

A topic search strategy was used to search the Web of Science Core Collection database. The 100 articles with the highest local citation scores were selected for bibliometric analysis; summarizing informetric indicators; and preparing a historiography, themes network, and key word co-occurrence map.

The 100 articles with the highest local citation scores were published from 1983 to 2013 in 9 countries, mainly in the United States. The most productive authors were Koenig and Rubinson. The lead research institution was Columbia University. The most commonly cited journal was the Annals of Emergency Medicine. The development of disaster medicine could be separated into 3 consecutive periods. All results indicate that the development of disaster medicine faces some obstacles that need to be addressed.

Research works have provided a solid foundation for disaster medicine, but its development has been in a slow growth period for a long time. Obstacles to the development of disaster medicine include the lack of scientist communities, transdisciplinary research, innovative research perspectives, and continuous research. Future research should overcome these obstacles so as to make further advances in this field.

Natural disasters have a significant impact on the health sector. On April 25, 2015, Nepal was struck by a 7.8 magnitude earthquake. The aim of the study was to compare patient volumes and clinical conditions presenting to the emergency department pre- and post-earthquake.

A retrospective study was done at Patan Hospital Emergency Department in Kathmandu, Nepal. Volume, demographics, and patient diagnoses were collected for 4 months post-disaster and compared with cases seen the same months the year before the disaster to control for seasonal variations.

After the 2015 Nepal earthquake, 12,180 patients were seen in the emergency department. This was a significant decrease in patient volume compared with the 14,971 patients seen during the same months in 2014 (P=0.04). Of those, 5496 patients (4093 pre-disaster and 1433 post-disaster) had a chief complaint or diagnosis recorded for analysis. An increase in cardiovascular and respiratory cases was seen as well as an increase in psychiatric cases (mostly alcohol related) and cases of anemia. There was a decrease in the number of obstetrics/gynecology, infectious disease, and poisoning cases post-earthquake.

Understanding emergency department utilization after the earthquake has the potential to give further insight into improving disaster preparedness plans for post-disaster health needs. (Disaster Med Public Health Preparedness. 2019;13:211–216).

We aimed to compare the pregnancy status of the pregnant women and birth status of their newborns, socioeconomic status, and access to health services, between high- and low-damage areas in Heris, affected by the Varzaghan Earthquake, 2012.

The study was conducted on pregnant women at any trimester of pregnancy (with complete medical profiles in local health centers) in August 2012 (time of the earthquake) who lived in Heris and delivered up to March 2013. Data were obtained on pregnancy- and infant-related variables, housing, socioeconomic status, and access to health services, including food supplies, before and after the earthquake.

Family income and mothers’ education were lower in highly damaged areas. Among these women, underweight at first trimester of pregnancy was higher, and weight gain during the last trimester was lower, compared with low-damage regions. Preterm delivery was higher in low-damage areas. Birth indices of the infants were not significantly different between the 2 areas; however, in highly damaged areas, moderate malnutrition was more prevalent among children under 1 year (weight-for-age) and under 2 years (height-for-age).

Socioeconomic status of mothers was lower in highly damaged areas and might have played a role in their own and newborns’ health status. (Disaster Med Public Health Preparedness. 2019;13: 511-518)

The purpose of this study was to investigate the 10-year impact of Hurricane Katrina on the incidence of acute myocardial infarction (AMI) along with contributing risk factors and any alteration in chronobiology of AMI.

A single-center, retrospective, comparison study of AMI incidence was performed at Tulane University Health Sciences Center from 2 years before Hurricane Katrina to 10 years after Hurricane Katrina. A 6-year, pre-Katrina and 10-year, post-Katrina cohort were also compared according to pre-specified demographic, clinical, and chronobiological data.

AMI incidence increased from 0.7% (150/21,079) to 2.8% (2,341/84,751) post-Katrina (P<0.001). The post-Katrina cohort had higher rates of coronary artery disease (36.4% vs. 47.9%, P=0.01), diabetes mellitus (31.3% vs. 39.9%, P=0.04), hyperlipidemia (45.4% vs. 59.3%, P=0.005), smoking (34.4% vs. 53.8%, P<0.001), drug abuse (10.2% vs. 15.4%, P=0.02), psychiatric illness (6.7% vs. 14.9%, P<0.001), medication non-adherence (7.3% vs. 15.3%, P<0.001), and lack of employment (7.2% vs. 16.4%, P<0.001). The post-Katrina group had increased rates of AMI during nights (29.8% vs. 47.8%, P<0.001) and weekends (16.1% vs. 29.1%, P<0.001).

Even 10 years after the storm, Hurricane Katrina continues to be associated with increased incidence of AMI, higher prevalence of traditional cardiovascular and psychosocial risk factors, and an altered chronobiology of AMI toward nights and weekends. (Disaster Med Public Health Preparedness. 2019;13:217–222)

After disasters, unaccompanied children may present to an emergency department requiring reunification. An effective reunification system depends on the willingness of guardians to utilize it.

Assess guardian willingness to share children’s personal information for reunification purposes after a disaster, perceived concerns and beliefs, and trust in reunification agencies.

Guardians of children presenting to 2 pediatric emergency departments were approached to participate in a survey-based study. Willingness to share their children’s personal information was scored on a scale of 1 to 19 (1 point per item). Perceived concerns about and importance of sharing information, level of trust in reunification agencies, and guardian demographics were collected. Chi-square was used to compare trust and attitudes/beliefs. Multivariate linear regression was used to determine factors associated with willingness to share information.

A total of 363 surveys were completed (response rate, 80%). Most guardians (95.6%) were willing to share at least some information (mean, 16 items; range, 1-19). Half were concerned about protection (55.4%) or abuse (52.3%) of their child’s information. Hospitals were trusted more than other reunification agencies (P < .001). Perception of reunification importance was associated with willingness to share (P < .001).

Guardians are willing to share their children’s information to facilitate reunification after disasters, but have privacy concerns.

The goal of this study was to assess the psychosocial consequences among nurses affected by the Great East Japan Earthquake in order to identify their coping strategies and explore possible countermeasures against complex disasters.

In 2012, we conducted a qualitative study and screened participants for posttraumatic stress disorder (PTSD).

Thirty-eight nurses participated in this study. The result showed a relatively high proportion of probable PTSD (39%). Thirty-two conceptual codes emerged from the data and were grouped into 8 categories: “initial acute stress,” “acute stress turning chronic,” “chronic physical and mental fatigue,” “occupational stress,” “fear of the impact of radiation on children’s health,” “occupational satisfaction,” “positive influences of the disaster experiences,” and “impact of mutual care through interpersonal cognition.”

The study reveals that mutual care may have a positive impact in assisting recovery and enhancing the psychological well-being of nurses. We suggest that disaster management should take into consideration the conflict between professional and family responsibilities. In the light of the chronic impact of the nuclear crisis, enhanced support for interpersonal relationships and human resources, as well as appropriate safety precautions, is urgently needed to help affected nurses. (Disaster Med Public Health Preparedness. 2019;13:519-526)

Theorists and researchers have linked resilience with a host of positive psychological and physical health outcomes. This paper examines perceptions of resilience and physical health symptoms in a sample of individuals exposed to multiple community disasters following involvement in integrated mental health services.

A multiwave naturalistic design was used to follow 762 adult clinic patients (72% female; 28% minority status), ages 18-92 years (mean age=40 years), who were evaluated for resilience and physical health symptoms prior to receiving services and at 1, 3, and 6 months’ follow-up.

Data indicated increases in perceptions of resilience and decreased physical health symptoms reported over time. Results also indicated that resilience predicted physical health symptoms, such that resilience and physical health symptoms were negatively associated (ie, improved resilience was associated with decreases in physical health symptoms). These effects were primarily observed for those individuals with previous exposure to natural disasters.

Findings provide correlational evidence for behavioral health treatment provided as part of a stepped-care, collaborative model in reducing physical health symptoms and increasing resilience post-disaster. Controlled trials are warranted. (Disaster Med Public Health Preparedness. 2019;13:223–229)

To increase knowledge of National Library of Medicine resources by using a train-the-trainer approach.

Workshops were held in spring 2016 to increase knowledge of 4 National Library of Medicine tools. Data were collected before the workshop and immediately, 3 months, and 1 year after the workshop. Knowledge questions were scored as 1 point per question; an aggregated knowledge score could range from 0 to 16 points. A paired t test assessed the change in knowledge from before to after the workshop.

Four workshops were hosted, with a total of 74 attendees. The response rate for the surveys ranged from 50% to 100%. Knowledge scores changed significantly from 7.2 to 11.9 (t = 15, P < .001). One year after the workshop, more of the participants reported having informally trained others (56.8%) than reported providing 1 or more formal training session (8.1%)(P < .001).

Objective measures of knowledge and information dissemination showed that the National Library of Medicine workshop was successful and resulted in both short- and long-term gains. This workshop could be repeated with other populations to further disseminate information regarding the National Library of Medicine tools, which could help improve disaster response.

The implementation of drones in the medical security system requires a proper planning of the cooperation of different services, dividing the area into sectors, assessing potential risks, and other factors. This study refers to the cost analysis of using drones in the medical support of mass events. The aim of this research is to analyze the costs of unmanned aerial vehicle (UAV) implementation in the mass event medical support system.

The description includes purchase and maintenance costs of UAVs. The analysis also involves ways of raising funds for projects related to the UAV sector. Apart from the financial aspect, staff and drone operator training issues are the subjects of this analysis as well.

This study is based on a specialist research involving drones and referring to reports on the current situation in Poland and in the world.

The presented funds required for such projects and the way of raising these funds illustrate the range of the project and its requirements. (Disaster Med Public Health Preparedness. 2019;13:527-532)

Health care workers performing rescue tasks in large-scale disaster areas are usually challenged in terms of physical and mental endurance, which can affect their lifestyles. Nevertheless, data on whether health care workers tend to adopt healthy lifestyles after disasters are limited. This paper compares the adoption of healthy lifestyle behaviors among health care workers with that among non–health care workers in a postdisaster area.

This cross-sectional observational study was conducted in August 2016. The Health-Promoting Lifestyle Profile II questionnaire was used to interview 261 health care workers and 848 non–health care workers.

Results of the multivariable linear models showed that health care workers had lower physical activity levels (ß=−1.363, P<.0001), worse stress management (ß=−1.282, P<.0001), slower spiritual growth (ß=−1.228, P=.002), and poorer interpersonal relationships (ß=−0.814, P=.019) than non–health care workers. However, no significant differences were found in either nutrition (ß=−0.362, P=.319) or health responsibility (ß=−0.421, P=.283).

Health care workers had less healthy lifestyle behaviors, including physical activity, stress management, spiritual growth, and interpersonal relationships. Further studies are needed to develop health-improving interventions for health care workers in postdisaster areas. (Disaster Med Public Health Preparedness. 2019;13:230–235)

Although dentists are valuable assets in identification teams during disaster events, forensic dentistry is not used effectively in the identification studies conducted in Turkey, and the importance of dental data is ignored. The aim of this study was to determine the level of knowledge of dentists regarding their duties and responsibilities during major disasters.

This descriptive study was conducted between December 2015 and June 2016. Registered dentists (n=20.280) of the Turkish Dental Association were invited to complete the organization’s online survey. A total of 539 dentists participated in the volunteer workshop. Data were analyzed using SPSS, version 22.0 (IBM Corp, Armonk, NY). The chi-square analysis was used to evaluate the knowledge level of dentists by group regarding disaster victim identification (DVI) – the process and procedure of recovering and identifying victims of major disasters (eg, earthquake, terrorist attack).

The dentists included in the study consisted of 320 (59.4%) females and 219 (40.6%) males with a mean age of 37.4±12.6 years. The number of specialists and general dentists were 249 (45.6%) and 297 (54.4%), respectively; 249 (69.71%) dentists who had knowledge about forensic dentistry stated that they received this information during their formal training. The percentage of dentists who were aware of the existence of an organization of a disaster response operation in Turkey was 74.2%, but only 20.5% (n=110) had knowledge about DVI. We found that 92.9% (n=104) of these dentists believed that dentists should be included in the team for the identification of disaster victims. On the other hand, only half (52.3%) of the dentists with knowledge of DVI wanted to work on the identification teams. The majority (99.1%) considered DNA analysis to be the safest method for identification.

Our findings show that, although dentists know about the identification process, they do not have enough relevant knowledge. (Disaster Med Public Health Preparedness. 2019;13:533-538)

This paper assesses the total medical costs associated with the US anthrax letter attacks of 2001. This information can be used to inform policies, which may help mitigate the potential economic impacts of similar bioterrorist attacks.

Journal publications and news reports were reviewed to establish the number of people who were exposed, were potentially exposed, received prophylactics, and became ill. Where available, cost data from the anthrax letter attacks were used. Where data were unavailable, high, low, and best cost estimates were developed from the broader literature to create a cost model and establish economic impacts.

Medical spending totaled approximately $177 million.

The largest expenditures stemmed from self-initiated prophylaxis (worried well): people who sought prophylactic treatment without any indication that they had been exposed to anthrax letters. This highlights an area of focus for mitigating the economic impacts of future disasters. (Disaster Med Public Health Preparedness. 2019;13:539-546)

The study aimed to gather data on posttraumatic stress and depression in adolescents following the 2015 Nepal earthquake and explore the adolescents’ coping strategies.

In a questionnaire-based, cross-sectional study about 1 year after the earthquake, adolescents in two districts with different degrees of impact were evaluated for disaster experience, coping strategies, and symptoms of posttraumatic stress and depression measured with the Child Posttraumatic Stress Scale and the Depression Self Rating Scale.

In the studied sample (N=409), the estimated prevalence of posttraumatic stress disorder (PTSD) (43.3%) and depression (38.1%) was considerable. Prevalence of PTSD was significantly higher in the more affected area (49.0% v 37.9%); however, the prevalence figures were comparable in adolescents who reported a stress. The prevalence of depression was comparable. Female gender, joint family, financial problems, displacement, injury or being trapped in the earthquake, damage to livelihood, and fear of death were significantly associated with a probable PTSD diagnosis. Various coping strategies were used: talking to others, praying, helping others, hoping for the best, and some activities were common. Drug abuse was rare. Most of the coping strategies were comparable among the clinical groups.

A considerable proportion of adolescents had posttraumatic stress and depression 1 year after the earthquake. There is a need for clinical interventions and follow-up studies regarding the outcome. Disaster Med Public Health Preparedness. 2019;13:236–242)