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)

In Cambodia, a highly landmine-contaminated country with endemic malaria, symptomatic falciparum malaria has been observed in patients presenting with traumatic landmine injuries. Because a link between recrudescence of symptomatic Plasmodium falciparum malaria and severe trauma is well established, we explored whether a link could be demonstrated between the geolocation of landmine amputations and malaria cases.

Landmine amputation data in Cambodia (2005–2008) were compared with predicted measures of malaria endemicity. Data of injuries that had resulted in amputation were plotted over a surface of P falciparum parasite rates.

No statistically significant correlation was found, possibly because the P falciparum endemicity surface was drawn from a model-based geostatistical prediction of infection prevalence and did not distinguish cases of recrudescence. The implication of this finding is that where symptomatic falciparum malaria has been observed in patients with landmine injuries, the cases were likely to be reactivated falciparum infections and not new cases.

Further research is needed to understand the relationship between P falciparum and trauma. To distinguish P falciparum recrudescence from new cases, a prospective registry is needed. Also, practitioners need to be aware of the possibility of post-injury malaria recrudescence in complex emergencies. (Disaster Med Public Health Preparedness. 2014;0:1-5)

The incidence of cardiovascular disease (CVD) reportedly increases following a huge disaster. On March 11, 2011, the Great East Japan Earthquake hit a large area of eastern Japan. In Fukushima prefecture, many people suffered from the consequences of the earthquake, the subsequent tsunami, and especially the Fukushima Daiichi Nuclear Power Plant accident. We assessed whether the incidence of acute myocardial infarction (AMI) increased after the earthquake.

We enrolled AMI patients admitted to 36 hospitals in Fukushima prefecture between March 11, 2009, and March 10, 2013 (n = 3068). We compared the incidence of AMI after the earthquake for more than 3 months and 1 year with that in the control years.

The incidence of Fukushima's annual AMI patients (per 100 000 persons) in 2011 was similar to that of previous years (n = 38.9 [2011] vs 37.2 [2009] and 38.5 [2010], P = .581). However, a significantly higher incidence of AMI was found in the Iwaki district after the disaster that corresponded to the 1-year period of observation (n = 38.7 [2011] vs 27.3 [2009] and 32.8 [2010], P = .045).

The Great East Japan Earthquake affected the incidence of AMI only in limited areas of Fukushima prefecture. (Disaster Med Public Health Preparedness. 2014;0:1–8)

Information on surges in critical care services including mechanical ventilator use during seasonal influenza outbreaks is limited. To potentially facilitate preparedness plans for future pandemics, we retrospectively quantitated surges in all-cause mechanical ventilator use during peak influenza for 12 consecutive years in all certified hospitals in Maryland.

Influenza testing data obtained for the Centers for Disease Control and Protection, Health and Human Services region 3, included defined peak influenza outbreak periods (PIOP), non-influenza time periods (non-ITP), and proportions of circulating influenza types for all study years. Procedure codes for mechanical ventilator use and diagnostic codes for medically attended acute respiratory illness (MAARI) were reviewed for every Maryland hospitalization. Daily counts of hospitalizations associated with ventilator use or MAARI during PIOP compared to non-ITP were analyzed using Poisson regression adjusted for month and year.

Ventilator use increased during PIOP by 7% (95% CI, 5-10) over non-ITP (P < .0001) for all study years. These annual surges correlated with influenza season intensity, as measured by MAARI-related hospitalizations (correlation coefficient = 0.91, P < .0001).

Surges in ventilator use were temporally associated with PIOP and were positively correlated with influenza season intensity, as measured by hospitalizations associated with acute respiratory illness. This information may assist resource planning for future pandemics. (Disaster Med Public Health Preparedness. 2014;x:1-7)

We briefly describe 2 systems that provided disaster-related mortality surveillance during and after Hurricane Sandy in New York City, namely, the New York City Health Department Electronic Death Registration System (EDRS) and the American Red Cross paper-based tracking system.

Red Cross fatality data were linked with New York City EDRS records by using decedent name and date of birth. We analyzed cases identified by both systems for completeness and agreement across selected variables and the time interval between death and reporting in the system.

Red Cross captured 93% (41/44) of all Sandy-related deaths; the completeness and quality varied by item, and timeliness was difficult to determine. The circumstances leading to death captured by Red Cross were particularly useful for identifying reasons individuals stayed in evacuation zones. EDRS variables were nearly 100% complete, and the median interval between date of death and reporting was 6 days (range: 0-43 days).

Our findings indicate that a number of steps have the potential to improve disaster-related mortality surveillance, including updating Red Cross surveillance forms and electronic databases to enhance timeliness assessments, greater collaboration across agencies to share and use data for public health preparedness, and continued expansion of electronic death registration systems. (Disaster Med Public Health Preparedness. 2014;8:489-491)

Natural disasters exacerbate risks of hazardous environmental exposures and adverse health consequences. The present study determined the proportion of previously identified lead industrial sites in urban locations that are at high risk for dispersal of toxic chemicals by natural disasters.

Geographic analysis from publicly available data identified former lead smelting plants that coincide with populated urban areas and with high-risk locations for natural disasters.

From a total of 229 urban smelting sites, 66 (29%) were in relatively high-risk areas for natural disasters: flood (39), earthquake (29), tornado (3), and hurricane (2). States with urban sites at relatively high risk for natural disaster included California (15); Pennsylvania (14); New York (7); Missouri (6); Illinois (5); New Jersey (4); Kentucky (3); Florida, Oregon, and Ohio (2 each); and Indiana, Massachusetts, Rhode Island, Texas, Utah, and Washington (1 each). Incomplete historical records showed at least 10 smelting site locations were affected by natural disaster.

Forgotten environmental hazards may remain hazardous in any community. Uncertainty about risks in disasters causes disruptive public anxiety that increases difficulties in community responses and recovery. Our professional and public responsibility is to seek a better understanding of the risks of latent environmental hazards. (Disaster Med Public Health Preparedness. 2014;0:1–7)

This study was conducted to test the ability of the St Louis County Department of Health to efficiently dispense medication to individuals with functional needs during a public health emergency and develop new guidelines for future emergency planning. Historically, people with functional needs have been vulnerable in emergency situations, and emergency planners are responsible for creating equal access for mass prophylaxis events.

Measures to create access for individuals with functional needs were tested in a countywide exercise in which 40 volunteers with functional needs walked through an open point of dispensing location to collect medication as if it were a real emergency. Actions were informed by representatives from the functional needs community in the St Louis area.

During the exercise, medications were successfully dispensed to all participants. Many participants offered feedback for future program design.

Outcomes indicated the importance of working closely with the community organizations that serve people with functional needs in designing appropriate response measures, providing sensitivity training to staff members, employing useful technology, and using visual and verbal cues. The lessons learned from this exercise apply to emergency planning nationwide, as planning efforts for persons with functional needs still lag significantly.(Disaster Med Public Health Preparedness. 2014;0:1–9)

To find the psychological competencies for surviving a disaster and develop a self-report questionnaire to assess them.

Interviews with 16 earthquake survivors and 16 fire fighters followed by qualitative analysis were used to find psychological competencies. Formation of the item pool, a pilot study among 20 college teachers and students, a series of principal component analyses for the data from 345 college students, and a confirmatory factor analysis for the data from 307 participants with various occupations were used to develop the Psychological Competencies for Surviving a Disaster Questionnaire (PCSDQ).

We found 4 psychological competencies: risk perception of a disaster, disaster knowledge and self-relief skills, low fear in a disaster, and sense of control over a disaster. The 24-item PCSDQ assessed these psychological competencies. The Cronbach alpha of PCSDQ subscales ranged from .75 to .87.

The psychological competencies for surviving a disaster were found to be risk perception of a disaster, disaster knowledge and self-relief skills, low fear in a disaster, and sense of control over a disaster. Using the PCSDQ to assess a person’s psychological competencies for disaster survival will make it possible to provide that person with an individualized and targeted disaster self-relief education and/or training program. (Disaster Med Public Health Preparedness. 2014;0:1-9)

Efficient emergency and disaster response is challenged by environmental conditions exceeding test reagent storage and operating specifications. We assessed the effectiveness of vial and foil packaging in preserving point-of-care (POC) glucose and lactate test strip performance in humid conditions.

Glucose and lactate test strips in both packaging were exposed to mean relative humidity of 97.0 ± 1.1% in an environmental chamber for up to 168 hours. At defined time points, stressed strips were removed and tested in pairs with unstressed strips using whole blood samples spiked to glucose concentrations of 60, 100, and 250 mg/dL (n = 20 paired measurements per level). A Wilcoxon signed rank test was used to compare stressed and unstressed test strip measurements.

Stressed glucose and lactate test strip measurements differed significantly from unstressed strips, and were inconsistent between experimental trials. Median glucose paired difference was as high as 12.5 mg/dL at the high glucose test concentration. Median lactate bias was −0.2 mmol/L. Stressed strips from vial (3) and foil (7) packaging failed to produce results.

Both packaging designs appeared to protect glucose and lactate test strips for at least 1 week of high humidity stress. Documented strip failures revealed the need for improved manufacturing process. (Disaster Med Public Health Preparedness. 2014;0:1–7)

On April 27, 2011, a train derailed and crashed in Taiwan, causing a mass casualty incident (MCI) that was similar to a previous event and with similar consequences. In both disasters, the emergency operating centers (EOCs) could not effectively integrate associated agencies to deal with the incident. The coordination and utilization of resources were inefficient, which caused difficulty in command structure operation and casualty evacuation.

This study was designed to create a survey questionnaire with problem items using disaster management phases mandated by Taiwan’s Emergency Medical Care Law (EMCL), use statistical methods (t test) to analyze the results and issues the EOCs encountered during the operation, and propose solutions for those problems.

Findings showed that EOCs lacked authority to intervene or coordinate with associated agencies. Also, placing emphasis on the recovery phase should improve future prevention and response mechanisms.

To improve the response to MCIs, the EMCL needs to be amended to give EOCs the lead during disasters; use feedback from the recovery phase to improve future disaster management and operation coordination; and establish an information-sharing platform across agencies to address all aspects of relief work.(Disaster Med Public Health Preparedness. 2014;0:1-6)

Mass gatherings (MGs) and special events typically involve large numbers of people in unfamiliar settings, potentially creating unpredictable situations. To assess the information available to guide emergency services and onsite medical teams in planning and preparing for potential mass casualty incidents (MCIs), we analyzed the literature for the past 30 years.

A search of the literature for MCIs at MGs from 1982 to 2012 was conducted and analyzed.

Of the 290 MCIs included in this study, the most frequently reported mechanism of injury involved the movement of people under crowded conditions (162; 55.9%), followed by special hazards (eg, airplane crashes, pyrotechnic displays, car crashes, boat collisions: 57; 19.6%), structural failures (eg, building code violations, balcony collapses: 38; 13.1%), deliberate events (26; 9%), and toxic exposures (7; 2.4%). Incidents occurred in Asia (71; 24%), Europe (69; 24%), Africa (48; 17%), North America (48; 27%), South America (27; 9%), the Middle East (25; 9%), and Australasia (2; 1%). A minimum of 12 877 deaths and 27 184 injuries resulted.

Based on our findings, we recommend that a centralized database be created. With this database, researchers can further develop evidence to guide prevention efforts and mitigate the effects of MCIs during MGs. (Disaster Med Public Health Preparedness. 2014;0:1-7)

An excess of deaths from cardiac causes are reported after many natural disasters. Despite the fact that floods are the most common and most destructive natural disaster worldwide, little is known about their effect on human health. We analyzed the influence of the greatest floods in the Czech Republic on cardiac mortality in the affected area.

This was a retrospective case-control study. We analyzed persons whose autopsies proved they had died of cardiac causes during the month of the flood, 2 months before the flood, 1 month after the flood, and during the same period in the 3 previous years.

A total of 207 of 985 autopsy reports met the criteria for inclusion in the study. There were no significant differences in the proportions of men and women (P=0.819) or in age (P=0.577). During the month of the flood, an increase in cardiac mortality was observed; however, the increase was not statistically significant (P=0.088).

According to our findings, the 1997 Central European flood did not significantly affect cardiac mortality. (Disaster Med Public Health Preparedness. 2014;8:492-496)

We propose a model of population behavior in the aftermath of disasters.

We conducted a qualitative analysis of an empirical dataset of 339 disasters throughout the world spanning from 1950 to 2005.

We developed a model of population behavior that is based on 2 fundamental assumptions: (i) behavior is predictable and (ii) population behavior will progress sequentially through 5 stages from the moment the hazard begins until is complete.

Understanding the progression of population behavior during a disaster can improve the efficiency and appropriateness of institutional efforts aimed at population preservation after large-scale traumatic events. Additionally, the opportunity for population-level intervention in the aftermath of such events will improve population health. (Disaster Med Public Health Preparedness. 2014;8:497-504)

The aim of this review was to systematically search and critique relevant literature on the potential psychological impact of earthquakes on peripartum women to synthesize existing knowledge for further action.

A search through 5 databases was conducted for relevant publications in English, and the results were screened through a set of inclusion and exclusion processes.

Eight articles were included. Depression and posttraumatic stress disorder were the most often reported mental disorders. Some factors (eg, family relationships and social support) were associated with mental disorders suffered by peripartum women after earthquakes. An assessment of the quality of the studies showed that most did not have high levels of evidence because of their cross-sectional design and limitations.

Among the factors that influenced the mental health of pregnant and postpartum women after earthquakes, family function appears to be one of the most important and deserves further exploration. Other mental health conditions such as minor psychiatric disorders should also be studied for their relationship with disasters and pregnancy. Well-designed studies are needed to enable a better understanding of the relationship between earthquakes and the mental disorders of peripartum women so that the most appropriate interventions can be proposed. (Disaster Med Public Health Preparedness. 2014;0:1–11)

After the Great Eastern Japan Earthquake and tsunami, the World Health Organization cautioned that evacuees at shelters would be at increased risk of infectious disease transmission; however, the frequency that occurred in this population was not known.

We reviewed medical charts of evacuees who visited medical clinics at 6 shelters from March 19, to April 8, 2011. Excluded were patients who did not reside within the shelters or whose medical records lacked a name or date. We investigated the frequency of and cumulative incidences of acute respiratory infection [ARI], acute gastroenteritis, acute jaundice syndrome, scabies, measles, pertussis, and tetanus.

Of 1364 patients who visited 6 shelter clinics, 1167 patients (86.1%) were eligible for the study. The median total number of evacuees was 2545 (interquartile range [IQR], 2277-3009). ARI was the most common infectious disease; the median number of patients with ARI was 168.8 per week per 1000 evacuees (IQR, 64.5-186.1). Acute gastroenteritis was the second most common; the median number of patients was 23.7 per week per 1000 evacuees (IQR, 5.1-24.3). No other infectious diseases were observed. The median cumulative incidence of ARI per 1000 evacuees in each shelter was 13.1 person-days (IQR, 8.5–18.8). The median cumulative incidence of gastroenteritis was 1.6 person-days (IQR, 0.3–3.4).

After the Great Eastern Japan Earthquake and tsunami, outbreaks of ARI and acute gastroenteritis occurred in evacuation shelters. (Disaster Med Public Health Preparedness. 2014;0:1-7)

The Mt Merapi volcanic eruption in October 2010 claimed more than 386 lives, injured thousands of survivors, and devastated the surrounding environment. No instrument was available in Indonesia to assess the psychosocial impact on survivors of environmental degradation caused by such natural disasters. We developed, translated, and tested an Indonesian version of the Environmental Distress Scale (EDS) for use as a tool to reliably measure environmental distress related to environmental damage in Indonesia.

The EDS, a prospective translation and psychometric study, was modified for use in a volcano disaster setting in Indonesia; translated into Indonesian; and pilot tested to determine meaning and cultural appropriateness. A test-retest study with 80 survivors of the 2010 Mt Merapi volcanic eruption measured the reliability of the tool.

The Indonesian version of the EDS (I-EDS) captured the content of the original EDS with appropriate adaptations for cultural differences of Indonesian natural disaster survivors.

The I-EDS can be considered a reliable tool for assessing the psychosocial impact of environmental degradation from natural disasters such as volcanic eruptions, which might be useful for Indonesian researchers. (Disaster Med Public Health Preparedness. 2014;0:1–10)

Healthcare workers (HCW) are at increased risk of infection during pandemics. HCW personal protective equipment (PPE) use has been shown to lower infection rates among HCW and patients. However, low compliance and misuse are frequent. Since future outbreaks are unavoidable, this issue needs to be addressed.

A validated questionnaire was distributed to 617 HCWs (nurses and physicians) in 21 hospitals and 40 primary care clinics in Israel at the peak of the A/H1N1 pandemic.

PPE confidence was higher among HCWs with higher tested and self-perceived knowledge. Confidence was also higher among nurses compared with physicians and among employees in hospitals compared with those in primary care clinics. Experience treating A/H1N1 patients was related to higher self-perceived knowledge and PPE confidence.

High levels of PPE knowledge were significantly correlated to HCWs’ confidence in PPE and may help increase PPE usage and reduce absenteeism. (Diaster Med Public Health Preparedness. 2014;0:1-8)