Objectives: The technology and resource-rich solutions of the developed world may not be completely applicable to or replicable in disasters occurring in the developing world. With the current looming hazards of pandemics, climate change, global terrorism and conflicts around the world, policy makers and governments will need high-quality scientific data to make informed decisions for preparedness and mitigation. The evidence on disasters in peer-reviewed journals about the developing world was examined for quality and quantity in this systematic review.

Methods: PubMed was searched using the Medical Subject Heading (MeSH) terms disasters, disaster medicine, rescue work, relief work, and conflict and then refined using the MeSH term developing country. The final list of selected manuscripts were analyzed by type of article, level of evidence, theme of the manuscript and topic, author affiliation, and region of the study.

Results: After searching and refining, <1% of the citations in PubMed addressed disasters in developing countries. The majority was original research articles or reviews, and most of the original research articles were level IV or V evidence. Less than 25% of the authors were from the developing world. The predominant themes were missions, health care provision, and humanitarian aid during the acute phase of disasters in the developing world.

Conclusions: Considering that 85% of disasters and 95% of disaster-related deaths occur in the developing world, the overwhelming number of casualties has contributed insignificantly to the world's peer-reviewed literature. Less than 1% of all disaster-related publications are about disasters in the developing world. This may be a publication bias, or it may be a genuine lack of submissions dealing with these disasters. Authors in this part of the world need to contribute to future disaster research through better-quality systematic research and better funding priorities. Aid for sustaining long-term disaster research may be a more useful investment in mitigating future disasters than short-term humanitarian aid missions to the developing world.

(Disaster Med Public Health Preparedness. 2011;5:112–116)

Introduction: Paramedics play an integral role in the response to and management of disasters and mass casualty events. Providing a core component of the front line response to disasters, paramedics potentially expose themselves to a variety of health and safety risks, including physical injury, death, communicable disease, and psychological effects. The health and safety risks to emergency service personnel were highlighted by the deaths of firefighters, paramedics, and police during the September 11, 2001, terrorist attacks, and the infection, illness, and deaths of paramedics and emergency health care staff during the severe acute respiratory syndrome outbreak in 2003.

Objective: Given that a willing and able prehospital workforce is a vital component of any successful response to a disaster situation, the present study explored paramedics' perception of risk and willingness to work, with a specific focus on identifying which type of disasters that paramedics associate with greater levels of fear, familiarity, and risk.

Methods: A total of 175 paramedics completed a survey ranking 40 disaster scenarios for levels of fear and familiarity.

Results: The results indicate that paramedics ranked nuclear and radiological events and outbreaks of new and highly infectious disasters highest for fear and unfamiliarity. This has implications for preparedness, education, and training.

(Disaster Med Public Health Preparedness. 2011;5:46-53)

As the systems that people depend on are increasingly strained by the coronavirus disease–2019 (COVID-19) outbreak, public health impacts are manifesting in different ways beyond morbidity and mortality for elderly populations. Loneliness is already a chief public health concern that is being made worse by COVID-19. Agencies should recognize the prevalence of loneliness among elderly populations and the impacts that their interventions have on loneliness. This letter describes several ways that loneliness can be addressed to build resilience for elderly populations as part of the public health response to COVID-19.

Pandemic influenza A (H1N1) commenced in April 2009. Robust planning and preparedness are needed to minimize the impact of a pandemic. This study aims to review if key elements of pandemic preparedness are included in national plans of European countries. Key elements were identified before and during the evaluations of the 2009 pandemic and are defined in this study by 42 items. These items are used to score a total of 28 publicly available national pandemic influenza plans. We found that plans published before the 2009 influenza pandemic score lower than plans published after the pandemic. Plans from countries with a small population size score significantly lower compared to national plans from countries with a big population (P <.05). We stress that the review of written plans does not reflect the actual preparedness level, as the level of preparedness entails much more than the existence of a plan. However, we do identify areas of improvement for the written plans, such as including aspects on the recovery and transition phase and several opportunities to improve coordination and communication, including a description of the handover of leadership from health to wider sector management and communication activities during the pre-pandemic phase. (Disaster Med Public Health Preparedness. 2019;13:582-592)

Background: Government reports have persistently indicated the intent of terrorists and hostile nations to acquire and “weaponize” nuclear materials for deliberate attack on a major US metropolitan city.

Methods: A modeling analysis of the effects of 20- and 550-kiloton nuclear detonations on the 2 major metropolitan centers of Los Angeles and Houston is presented with a focus on thermal casualties. Brode’s work as modified by Binninger was used to calculate thermal fluence, using thermal fractions. The EM-1 and WE programs were used to calculate blast effects. Fallout radiation was calculated using the Defense Threat Reduction Agency’s Hazard Prediction and Assessment Capability V404SP4 with “urban effects” turned on. The ESRI ArcView program calculated affected populations from 2000 US Census block-level data for areas affected by thermal effects.

Results: The population affected by a 550-kiloton nuclear weapon detonated in Los Angeles and Houston is staggering: surviving thermal casualties are estimated at 185,000 and 59,000, respectively. Even the 20-kiloton detonations in Los Angeles and Houston are significant: the numbers of surviving thermal casualties requiring care exceed 28,000 and 10,000, respectively.

Conclusions: The surviving health care community postdetonation would be faced with an unprecedented burden of care for thermal casualties. A great expansion of personnel involved in emergency burn care response is critical. Bold, new approaches such as regionalization and predetermined medical air transport need to be considered. (Disaster Med Public Health Preparedness. 2007;1:80–89)

Fetal sensitivity to radiation-induced health effects is related to gestational age, and it is highly dependent on fetal dose. Typical fetal doses from diagnostic radiology are usually below any level of concern. Although rare, significant fetal radiation doses can result from interventional medical exposures (fluoroscopically guided techniques), radiation therapy, or radiological or nuclear incidents, including terrorism. The potential health effects from these large radiation doses (possibly large enough to result in acute radiation syndrome in the expectant mother) include growth retardation, malformations, impaired brain function, and neoplasia. If exposure occurs during blastogenesis (and the embryo survives), there is a low risk for congenital abnormalities. (In all stages of gestation, radiation-induced noncancer health effects have not been reported for fetal doses below about 0.05 Gy [5 rad].) The additional risk for childhood cancer from prenatal radiation exposure is about 12% per Gy (0.12%/rad) above the background incidence.

(Disaster Med Public Health Preparedness. 2011;5:62-68)

Methods: An effective disaster response requires competent responders and leaders. The purpose of this study was to ask experts to identify attributes that distinguish effective from ineffective responders and leaders in a disaster. In this qualitative study, focus groups were held with jurisdictional medical directors for the 9-1-1 emergency medical services systems of the majority of the nation's largest cities. These sessions were recorded with audio equipment and later transcribed.

Results: The researchers identified themes within the transcriptions, created categories, and coded passages into these categories. Overall interrater reliability was excellent (κ = .8). The focus group transcripts yielded 138 codable passages. Ten categories were developed from analysis of the content: Incident Command System/Disaster Training/Experience, General Training/Experience, Teamwork/Interpersonal, Communication, Cognition, Problem Solving/Decision Making, Adaptable/Flexible, Calm/Cool, Character, and Performs Role. The contents of these categories included knowledge, skills, attitudes, behaviors, and personal characteristics.

Conclusions: Experts in focus groups identified a variety of competencies for disaster responders and leaders. These competencies will require validation through further research that involves input from the disaster response community at large.

(Disaster Med Public Health Preparedness. 2010;4:332-338)

Novel approaches to improving disaster response have begun to include the use of big data and information and communication technology (ICT). However, there remains a dearth of literature on the use of these technologies in disasters. We have conducted an integrative literature review on the role of ICT and big data in disasters. Included in the review were 113 studies that met our predetermined inclusion criteria. Most studies used qualitative methods (39.8%, n=45) over mixed methods (31%, n=35) or quantitative methods (29.2%, n=33). Nearly 80% (n=88) covered only the response phase of disasters and only 15% (n=17) of the studies addressed disasters in low- and middle-income countries. The 4 most frequently mentioned tools were geographic information systems, social media, patient information, and disaster modeling. We suggest testing ICT and big data tools more widely, especially outside of high-income countries, as well as in nonresponse phases of disasters (eg, disaster recovery), to increase an understanding of the utility of ICT and big data in disasters. Future studies should also include descriptions of the intended users of the tools, as well as implementation challenges, to assist other disaster response professionals in adapting or creating similar tools. (Disaster Med Public Health Preparedness. 2019;13:353–367)

Objective: Participatory action research (PAR) methodology is an effective tool in identifying and implementing risk-reduction interventions. It has been used extensively in occupational health research, but not, to our knowledge, in disaster research. A PAR framework was incorporated into the World Trade Center evacuation study, which was designed to identify the individual, organizational, and structural (environmental) factors that affected evacuation from the World Trade Center Towers 1 and 2 on September 11, 2001. PAR teams—comprising World Trade Center evacuees, study investigators, and expert consultants—worked collaboratively to develop a set of recommendations designed to facilitate evacuation from high-rise office buildings and reduce risk of injury among evacuees.

Methods: Two PAR teams worked first separately and then collectively to identify data-driven strategies for improvement of high-rise building evacuation.

Results: The teams identified interventions targeting individual, organizational, and structural (environmental) barriers to safe and rapid evacuation.

Conclusions: PAR teams were effective in identifying numerous feasible and cost-effective strategies for improvement of high-rise emergency preparedness and evacuation. This approach may have utility in other workplace disaster prevention planning and response programs. (Disaster Med Public Health Preparedness. 2008;2:142–149)

According to many experts, a public health emergency arising from an influenza pandemic, bioterrorism attack, or natural disaster is likely to develop in the next few years. Meeting the public health and medical response needs created by such an emergency will likely involve volunteers, health care professionals, public and private hospitals and clinics, vaccine manufacturers, governmental authorities, and many others. Conducting response activities in emergency circumstances may give rise to numerous issues of liability, and medical professionals and other potential responders have expressed concern about liability exposure. Providers may face inadequate resources, an insufficient number of qualified personnel, overwhelming demand for services, and other barriers to providing optimal treatment, which could lead to injury or even death in some cases. This article describes the different theories of liability that may be used by plaintiffs and the sources of immunity that are available to public health emergency responders in the public sector, private sector, and as volunteers. It synthesizes the existing immunity landscape and analyzes its gaps. Finally, the authors suggest consideration of the option of a comprehensive immunity provision that addresses liability protection for all health care providers during public health emergencies and that, consequently, assists in improving community emergency response efforts. (Disaster Med Public Health Preparedness. 2009;3:117–125)

Social capital (SC) is highlighted as an important factor for post-crisis mental health outcomes. However, the heterogeneous nature of the construct makes it difficult to get a clear picture of the evidence concerning the association between SC indices and mental health. This review examines how SC is conceptualized and measured, and the relationships with other variables in quantitative empirical studies investigating the associations between SC and mental health in post-disaster and post-conflict contexts. It includes primary data studies focusing on this association in civilian populations. Studies were identified by searching electronic databases, bibliographic mining, cited reference searching, and personal contact with experts. In total, 15 studies were included: 12 in post-natural disaster contexts and 3 in conflict-affected settings. Findings suggested that individual cognitive SC had an inverse association with post-traumatic stress disorder, anxiety, and depression, and that ecological cognitive SC was positively associated with mental well-being. Individual structural SC (in the form of community networks) may be psychologically protective. However, most of the evidence was cross-sectional, limiting conclusions about causal relationships. More clarity and consistency is needed in the conceptualization and measurement of SC in order to inform post-crisis mental health interventions. (Disaster Med Public Health Preparedness. 2018;12:791-802)