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)

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 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)

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)

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)

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)

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 use of spontaneous volunteers (SV) is common after a disaster, but their limited training and experience can create a danger for the SVs and nongovernmental voluntary organizations (NVOs). We assessed the experience of NVOs with SVs during disasters, how they were integrated into the agency's infrastructure, their perceived value to previous responses, and liability issues associated with their use.

Of the 51 National Voluntary Organizations Active in Disasters organizations that were contacted for surveys, 24 (47%) agreed to participate.

Of the 24 participating organizations, 19 (72%) had encountered SVs during a response, most (79%) used them regularly, and 68% believed that SVs were usually useful. SVs were always credentialed by 2 organizations, and sometimes by 6 (31%). One organization always performed background checks; 53% provided just-in-time training for SVs; 26% conducted evaluations of SV performance; and 21% provided health or workers compensation benefits. Two organizations reported an SV death; 42% reported injuries; 32% accepted legal liability for the actions of SVs; and 16% were sued because of actions by SVs.

The use of SVs is widespread, but NVOs are not necessarily structured to incorporate them effectively. More structured efforts to integrate SVs are critical to safe and effective disaster response. (Disaster Med Public Health Preparedness. 2014;8:65-69)

Disaster health workers currently have no common standard based on a shared set of competencies, learning objectives, and performance metrics with which to develop courses or training materials relevant to their learning audience. We examined how existing competency sets correlate within the 2012 pyramidal learning framework of competency sets in disaster medicine and public health criteria and describe how this exercise can guide curriculum developers.

We independently categorized 35 disaster health-related competency sets according to the 4 levels and criteria of the pyramidal learning framework of competency sets in disaster medicine and public health.

Using the hierarchical learning framework of competency sets in disaster medicine and public health criteria as guidance, we classified with consistency only 10 of the 35 competency sets.

The proposed series of minor modifications to the framework should allow for consistent classification of competency sets. Improved education and training of all health professionals is a necessary step to ensuring that health system responders are appropriately and adequately primed for their role in disasters. Revising the organizing framework should assist disaster health educators in selecting competencies appropriate to their learning audience and identify gaps in current education and training. (Disaster Med Public Health Preparedness. 2014;8:70-78)

We assessed the feasibility and impact on knowledge, attitudes, and reported practices of psychological first-aid (PFA) training in a sample of Medical Reserve Corps (MRC) members. Data have been limited on the uptake of PFA training in surge responders (eg, MRC) who are critical to community response.

Our mixed-methods approach involved self-administered pre- and post-training surveys and within-training focus group discussions of 76 MRC members attending a PFA training and train-the-trainer workshop. Listen, protect, connect (a PFA model for lay persons) focuses on listening and understanding both verbal and nonverbal cues; protecting the individual by determining realistic ways to help while providing reassurance; and connecting the individual with resources in the community.

From pre- to post-training, perceived confidence and capability in using PFA after an emergency or disaster increased from 71% to 90% (P < .01), but no significant increase was found in PFA-related knowledge. Qualitative analyses suggest that knowledge and intentions to use PFA increased with training. Brief training was feasible, and while results were modest, the PFA training resulted in greater reported confidence and perceived capability in addressing psychological distress of persons affected by public health threats.

PFA training is a promising approach to improve surge responder confidence and competency in addressing postdisaster needs. (Disaster Med Public Health Preparedness. 2014;0:1-6)

The aim of this report is to identify from the literature common themes relating to the concept of hospital preparedness for emergencies to develop an agreed framework for evaluation.

A systematic literature search identified appropriate articles for critical appraisal. A meta-ethnography approach was used to synthesize the findings, using both reciprocal translation and line-of-argument synthesis.

From an initial 2162 articles, we identified 13 articles that specifically addressed the aims of this review and formed the basis of the intended analysis.

Hospital emergency preparedness is essential for effective disaster relief. Developing a systematic and structured methodology is necessary to assess hospital preparedness. (Disaster Med Public Health Preparedness: 2014:0:1-9)