We examined the association between housing type and household emergency preparedness among households in Oakland County, Michigan.

We used interview data on household emergency preparedness from a cluster design survey in Oakland County, Michigan, in 2012. We compared survey-weighted frequencies of household demographics, medical conditions, and preparedness measures in single-detached homes versus multi-unit dwellings, and determined the unadjusted odds ratios (OR) and the income-level adjusted OR for each preparedness measure.

Households had similar demographics and medical conditions between housing types. Unadjusted ORs were statistically significant for single detached homes having a generator (11.1), back-up heat source (10.9), way to cook without utilities (5.8), carbon monoxide (CO) detector (3.8), copies of important documents (3.4), evacuation routes (3.1), and 3-day supply of water (2.5). Income level adjusted ORs remained statistically significant except for owning a CO detector.

Households in multi-unit dwellings were less likely to have certain recommended emergency plans and supplies compared to those in single detached homes. Further research is required to explore the feasibility, barriers, and alternatives for households in multi-unit dwellings in terms of complying with these measures. (Disaster Med Public Preparedness. 2014;0:1–8)

To identify factors that affected well-being among British embassy staff based in Japan after the 2011 earthquake, tsunami, and nuclear meltdown.

In-depth qualitative interviews were conducted with 36 members of staff 8 to 9 months after the earthquake.

Participants described their crisis work as stressful, exciting, and something of which they were proud. Aside from disaster-specific stressors, factors identified as stressful included unclear roles, handing over work to new personnel, being assigned to office-based work, feeling that work was not immediately beneficial to the public, not taking good-quality breaks, and difficulties with relatives. The radiation risk provoked mixed feelings, with most participants being reassured by contact with senior scientists.

Interventions to safeguard the well-being of personnel during crisis work must consider the impact of a broad range of stressors.(Disaster Med Public Health Preparedness. 2014;0:1-7)

To elucidate the impacts of nuclear plant accidents on neighboring medical centers, we investigated the operations of our hospital within the first 10 days of the Great East Japan Earthquake followed by the Fukushima Daiichi nuclear power plant accident.

Data were extracted from medical records and hospital administrative records covering 11 to 20 March 2011. Factual information on the disaster was obtained from public access media.

A total of 622 outpatients and 241 inpatients were treated. Outpatients included 43 injured, 6 with cardiopulmonary arrest, and 573 with chronic diseases. Among the 241 inpatients, 5 died, 137 were discharged, and the other 99 were transferred to other hospitals. No communication methods or medical or food supplies were available for 4 days after the earthquake. Hospital directors allowed employees to leave the hospital on day 4. All 39 temporary workers were evacuated immediately, and 71 of 239 full-time employees remained. These employees handled extra tasks besides patient care and patient transfer to other hospitals. Committed effective doses indicating the magnitude of health risks due to an intake of radioactive cesium into the human body were found to be minimal according to internal radiation exposure screening carried out from July to August 2011.

After the disaster, hospitals located within the evacuation zone of a 30-km radius of the nuclear power plant were isolated. Maintenance of the health care system in such an event becomes difficult. (Disaster Med Public Health Preparedness. 2014;8:471-476)

Occupational injury and illness rates for volunteer responders have not been well documented. We analyzed data specific to volunteers from the American Red Cross (ARC).

Data collected by the ARC between 2008 and 2012 were analyzed to identify disaster factors associated with responder injuries and illnesses. We focused on disaster-relief operation (DRO) level (indicating operational costs, ranging from 3 [lower] to 5+ [higher]); disaster type; region; and year. We calculated injury and illness rates and estimated rate ratios (RR) with 95% CI, using negative binomial regression. Also, we analyzed a total of 113 disasters.

Hurricanes had the highest rates of injuries (14/1000 responders) and illnesses (18/1000 responders). In the adjusted model for injuries, RRs were higher for DRO levels 4 (3.6 [CI, 2.0–6.7]) and 5+ (4.9 [CI, 2.2–11.0]) than for level 3. In the adjusted model for illnesses, RRs also were higher for DRO levels 4 (4.4 [CI, 2.6–7.3]) and 5+ (8.6 [CI, 4.1–17.7]) than for level 3.

Higher DRO levels were a significant predictor of greater rates of occupational injuries and illnesses. Careful selection of responders, including volunteers, has been warranted for deployments to such disasters. (Disaster Med Public Health Preparedness. 2014;0:1-7)

A variety of hazards can precipitate the full or partial collapse of occupied structures. The rescue of entrapped survivors in these situations can be complex, require a multidisciplinary approach, and last for many hours.

The modern discipline of Urban Search and Rescue, which includes an active medical component, has evolved to address such situations. This case series spans several decades of experience and highlights the medical principles in the response to collapsed structure incidents.

Recurring concepts of confined space medicine include rescuer safety, inter-disciplinary coordination, patient protection, medical resuscitation in austere environments, and technical extrications.

Strategies have been developed to address the varied challenges in the medical response to collapsed structure incidents. (Disaster Med Public Health Preparedness. 2014;0:1–10)

The objective of this study was to draft a new Japanese Disaster Medical Assistance Team (DMAT) training program based on the responses to the Great East Japan Earthquake.

Working group members of the Japan DMAT Investigative Commission, Ministry of Health, Labour and Welfare, reviewed reports and academic papers on DMAT activities after the disaster and identified items in the current Japanese DMAT training program that should be changed. A new program was proposed that incorporates these changes.

New topics that were identified to be added to the DMAT training program were hospital evacuation, preparations to receive DMATs at damaged hospitals, coordination when DMAT activities are prolonged, and safety management and communication when on board small helicopters. The use of wide-area transport was reviewed and changes were made to cover selection of various transport means including helicopter ambulances. Content related to confined space medicine was removed. The time spent on emergency medical information system (EMIS) practical training was increased. Redundant or similar content was combined and reorganized, and a revised DMAT training program that did not increase the overall training time was designed.

The revised DMAT training program will provide practical training better suited to the present circumstances in Japan. (Disaster Med Public Health Preparedness. 2014;8:477-484)

The 2011 earthquake and Fukushima nuclear disaster in Japan have had devastating effects on residents near the damaged nuclear power plant, but quantifying its effect on their health has been difficult.

Among the 564 residents of Iitate Village and Soma City who enrolled in this study, we evaluated the changes of clinical parameters in 155 participants who underwent annual health evaluations in the previous year and after the earthquake. Psychological distress was also measured by using patient health questionnaire 9 (PHQ-9).

Participants (median age, 64 years) showed significant post-disaster increases in body weight, body mass index, systolic and diastolic blood pressure, blood glucose levels, and triglyceride levels. PHQ-9 scores of 10 or greater were found in 12% of the subjects, indicating that a substantial number had major depression.

The findings in this study showed substantial deterioration in clinical parameters related to lifestyle diseases and the presence of general psychological distress among residents living near the damaged nuclear power plant after the Fukushima Daiichi disaster. In addition to controlling the levels of radiation exposure, aggressive management of immediate physical and mental health crisis for residents may be necessary in future nuclear accidents. (Disaster Med Public Health Preparedness. 2014;0:1–7)

Since 2003, the Chinese National Health and Family Planning Commission (formerly the Ministry of Health) has implemented changes to more effectively communicate risk during public health emergencies. In spite of ongoing improvements, provincial and sub-provincial leaders face barriers, such as established modes of operation, lack of training, shortage of trained risk communicators, and limited understanding and willingness of recipients to mitigate risks.

We assessed the current status of and barriers to risk communication knowledge and practice among public health practitioners in China. We designed the survey questionnaire to capture information related to the risk communication core capacities required by international health regulations and common risk communication principles.

Our findings showed that risk communication training has successfully developed an awareness of risk communication principles and the ability to implement those principles in practice in China.

Future efforts should focus on areas such as a dedicated risk communication workforce, requirements that public health agencies develop a risk communication plan, and additional training for public health practitioners and their partners. It is critical that the infectious diseases prevention and control law be amended to grant provincial and local public health agencies more autonomy to release information. (Disaster Med Public Health Preparedness. 2014;0:1-7)

The Great East Japan Earthquake occurred at 14:46 on March 11, 2011, producing serious and widespread damage. To assess damages in hospital operating departments during and after the earthquake, we surveyed hospitals in this region.

Questionnaires were sent to 415 acute care hospitals in Tohoku and east Kanto areas. The questionnaires elicited the number of perioperative patients when the earthquake hit, obstacles to continuing surgery, structural and nonstructural damage to the operating department, and the effect on routine surgery after the earthquake.

Of the 213 hospitals (51%) that completed questionnaires, 474 patients were undergoing operations during the earthquake, and 222 operations were canceled afterward. Risk factors for continuing operations, as reported by 102 hospitals, were tremors and electrical blackouts (odds ratio [OR]: 79.3 and 110.5; P < .01). In 154 hospitals, difficulties in performing operations after the earthquake were reported. Significant obstacles to the management of operations after the earthquake were characterized by infrastructure disorder scores, seismic intensity, disruption of electrical power and air conditioning, and damage to out-of-hospital telecommunications (OR, 0.46; P = .04).

Tremors and electrical blackouts were important risk factors for performing operations. Nonstructural damage, especially to out-of-hospital telecommunications, affected the management of the operating rooms. Hospital logistics are very important to achieve appropriate disaster management. (Disaster Med Public Health Preparedness. 2014;0:1–7)

After the 2011 Great East Japan Earthquake, the resource utilization of and the problems encountered with communication devices were examined.

A questionnaire survey was submitted to disaster medical assistance teams (DMATs) that were at the primary sites of destruction after the earthquake.

We collected data from 196 teams. During the first 4 days after the earthquake, the use of mobile phones, laptop computers, and landline phones was rated as poor to moderate, and satisfaction was very low, while satisfaction with satellite phones was rated as good to moderate (50%). The degree of satisfaction continued to increase gradually over time. Satellite phones, however, had several problems: poor reception, line instability, voice call use only, and inability to send large amounts of data.

To ensure effective communication during the acute phase in the aftermath of large disasters, a new satellite communication device is needed that not only is portable, battery powered, and able to send large volumes of data, but also offers stable communication. (Disaster Med Public Health Preparedness. 2014:0:1–4)

Skin contamination is one of the most likely risks after accidental or occupational radiological accidents. Using scintigraphy, we assessed a topical lotion for its decontamination efficacy (DE) after exposure with short-lived medical radioisotopes technetium Tc 99m (99mTc) and thallium 201Tl (201Tl).

Using 99mTc (300 ± 5 μCi/100 μl) and 201Tl (100 ± 5 μCi/100 μl), the thoracoabdominal region (shaved skin) of Sprague Dawley rats and human tissue equivalent were contaminated and then decontaminated using cotton swabs soaked in formulated lotion at different time intervals. Static counts were recorded and calculated for DE. Histologic examination was performed on the animal model.

The DE of the formulation for 99mTc and 201Tl was 85% ± 5 and 88% ± 2, respectively. The prepared formulation effectively removed the radionuclides from the tissue surface.

The formulated lotion assisted in the effective removal of radiocontaminants by decontaminating the radionuclides. Moreover, minimal and easily manageable radioactive waste was generated by this process. Further investigation regarding the infusion of formulated lotion into ready-to-use skin wipes for self-decontamination may be useful for mass casualty scenarios. (Disaster Med Public Health Preparedness. 2014;0:-)

Risk communication plays a central role in the management of infectious disease. The World Health Organization's 2005 International Health Regulations have highlighted the need for countries to strengthen their capacities in this area to ensure effective responses to public health emergencies. We surveyed laboratories, hospitals, and public health institutions in Germany to detail the current situation regarding risk communication and crisis management and to identify which areas require further development.

A mixed methods approach was adopted. An initial questionnaire was distributed to relevant persons in laboratories and hospitals, and semistructured interviews were conducted with selected participants. Representatives from state public health authorities, federal agencies, and media also were interviewed to add additional contextual information to the questionnaire responses.

Based on the responses received, the universal sense among key stakeholders was that risk communication and crisis communication measures must be improved. Collaborative working was a consistent theme, with participants suggesting that a partnering strategy could help to improve performance. This approach could be achieved through better coordination between groups, for example, through a knowledge-sharing policy.

More research is needed on how such collaboration might be implemented, along with a general conceptual framework for risk communication to underpin the overall strategy. (Disaster Med Public Health Preparedness. 2014;0:1-6)

To obtain insights into disaster management among dental graduates in a dental institute in India.

A total of 103 of 104 house surgeons in Shri Dharmasthala Manjunatheswar College of Dental Sciences and Hospital, Dharwad, participated in the main study (response rate = 99.04%). Their knowledge, attitude, and behavior regarding disaster management were assessed by use of a survey questionnaire. Information was also collected regarding age, gender, religion, and residence.

Mean knowledge, attitude, and behavior scores toward disaster management were 45.46%, 79.53%, and 37.70%, respectively. A significant relationship was observed between knowledge and attitude scores (r = 0.248, P = .012). No significant differences were found in knowledge, attitude, and behavior by gender, religion, and residence. Religion was a significant predictor of knowledge scores (χ2 = 10.108, P = .006).

Respondents had favorable attitudes toward disaster management, but their knowledge and behavior required considerable improvement. Knowledge of the respondents was significantly associated with their attitude. This pilot study highlights the need for curriculum changes in dental education in India and further nationwide study. (Disaster Med Public Health Preparedness. 2014;0:1-7)

We evaluated the knowledge of physicians, nurses, and paramedics in Poland about the procedures in a chemical contamination.

An anonymous survey was mailed to 600 randomly selected physicians, nurses, and paramedics. The survey included questions concerning the process of decontamination, knowledge of toxidromes, and the use of selected antidotes.

Completed surveys were received from 510 respondents (85%). A very low level of knowledge was observed regarding decontamination techniques (from 8.3% to 34.2%), use of antidotes (from 13.7% to 61%), and knowledge of toxidromes (from 10.2% to 22.7%).

Our findings showed that for all aspects of chemical rescue procedures queried, the knowledge of medical personnel was not satisfactory. Both practical and theoretical training of medical personnel is urgently needed for life-saving procedures during a chemical contamination. (Disaster Med Public Health Preparedness. 2014:0:1–4)