To assess the level of all-hazards disaster preparedness and training needs of emergency department (ED) doctors and nurses in Hong Kong from their perspective, and identify factors associated with high perceived personal preparedness.

This study was a cross-sectional territory-wide online survey conducted from 9 September to 26 October, 2015.

The participants were doctors from the Hong Kong College of Emergency Medicine and nurses from the Hong Kong College of Emergency Nursing.

We assessed various components of all-hazards preparedness using a 25-item questionnaire. Backward logistic regression was used to identify factors associated with perceived preparedness.

A total of 107 responses were analyzed. Respondents lacked training in disaster management, emergency communication, psychological first aid, public health interventions, disaster law and ethics, media handling, and humanitarian response in an overseas setting. High perceived workplace preparedness, length of practice, and willingness to respond were associated with high perceived personal preparedness.

Given the current gaps in and needs for increased disaster preparedness training, ED doctors and nurses in Hong Kong may benefit from the development of core-competency-based training targeting the under-trained areas, measures to improve staff confidence in their workplaces, and efforts to remove barriers to staff willingness to respond. (Disaster Med Public Health Preparedness. 2018; 12: 329–336)

Mosquito-borne diseases pose a threat to individual health and population health on both a local and a global level. The threat is even more exaggerated during disasters, whether manmade or environmental. With the recent Zika virus outbreak, it is important to highlight other infections that can mimic the Zika virus and to better understand what can be done as public health officials and health care providers.

This article reviews the recent literature on the Zika virus as well as chikungunya virus and dengue virus.

The present findings give a better understanding of the similarities and differences between the 3 infections in terms of their characteristics, clinical presentation, diagnosis methodology, and treatment and what can be done for prevention. Additionally, the article highlights a special population that has received much focus in the latest outbreak, the pregnant individual.

Education and training are instrumental in controlling the outbreak, and early detection can be lifesaving. (Disaster Med Public Health Preparedness. 2017;11:290–299).

The aim of this study is to assess the knowledge (K), attitude (A), and readiness to practice (rP) levels regarding disaster medicine and preparedness among health profession students at Qatar University.

A survey-based study was carried out to assess medical, pharmacy, and health sciences students’ KArP levels using pretested and validated questionnaire. Student’s t-test, analysis of variance, correlation, and linear regression were used with an alpha level of 0.05.

The difference in the mean KArP level between genders was not significant (P > 0.05). Students from the College of Health Sciences had significantly higher KArP levels than those from the College of Pharmacy (101.5 vs 90.0; P = 0.033). Overall, Qatari students had better knowledge, attitude, and readiness to practice scores and total KArP scores than non-Qatari students. Moreover, students who were born in Qatar also had better knowledge, attitude, and readiness to practice scores and total KArP scores than students who were born outside Qatar. Significant direct moderate correlations were found among the 3 KArP parameters (P < 0.001). Knowledge and attitudes were indicated to be significant predictors of readiness to practice (P < 0.001).

Students from the health colleges at Qatar University have moderate disaster medicine preparedness

Studies quantifying relationships between floods and diarrheal diseases have mainly been conducted in low-latitude regions. It’s therefore increasingly important to examine these relationships in midlatitude regions, where they may have significant public health implications. This study aimed to examine the association between floods and bacillary dysentery in the city of Dalian, China.

A generalized additive mixed model was applied to examine the association between floods and bacillary dysentery. The relative risk (RR) of flood impact on bacillary dysentery was estimated.

A total of 18,976 cases of bacillary dysentery were reported in Dalian during the study period. Two weeks’ lagged effect was detected from the impact of floods on bacillary dysentery. The RR of flood impact on bacillary dysentery was 1.17 (95% CI: 1.03-1.33).

Floods have significantly increased the risk of bacillary dysentery in Dalian. More studies should focus on the association between floods and infectious diseases in different regions. Our findings have significant implications for managing the negative health impact of floods in the midlatitude region of China. (Disaster Med Public Health Preparedness. 2017;11:190–195)

The purpose of the study is to describe changes in mental health among women following an oil spill and to examine their association with the Deepwater Horizon oil spill (DHOS).

The Women and Their Children’s Health study followed 2038 women in Louisiana after the DHOS. Subjects were interviewed in 2012-2014 and 2014-2016. Oil spill exposure was characterized using survey items about economic and physical exposures. Outcomes were depressive symptoms and mental distress.

After adjustment for relevant demographics, depressive symptoms increased over 2 time points following the DHOS, whereas symptoms of mental distress decreased. For every year increase in time since the DHOS, the rate ratio for depressive symptoms increased by a factor of 1.08. In contrast, the rate ratio for mental distress decreased by a factor of 0.97. In addition, initial associations between economic and physical exposure to the DHOS persisted up to 6 years after the spill; women who were more highly exposed experienced higher levels of depressive symptoms (rate ratios ranged from 1.08 to 1.11) and mental distress (rate ratios from 1.05 to 1.11) at each time point than women who were less exposed.

A better understanding of recovery patterns following an oil spill can help direct critical mental health response efforts. (Disaster Med Public Health Preparedness. 2019;13:183–190)

This brief report examines the shift from in-person care to US Department of Veterans Affairs (VA) telehealth services during 3 devastating hurricanes in 2017 (Harvey, Irma, and Maria).

VA administrative data were used to analyze the number and percentage of telehealth services 30 d pre- and 30 d post- the 2017 hurricanes for 3 hurricane-impacted VA medical centers (VAMCs): Houston (Texas), Orlando (Florida), and San Juan (Puerto Rico).

All 3 VAMCs remained open during the hurricanes. For the Houston VAMC, during the first week post-Harvey, in-person patient visits decreased while telehealth visits increased substantially. Similarly, for the Orlando VAMC, during the 1-wk post-Irma, telehealth use increased substantially. For the San Juan VAMC, there were many interruptions in the use of telehealth due to many power outages, resulting in a modest increase in the use of telehealth post-Irma/Maria. The most commonly used telehealth services at Houston and Orlando VAMCs during the hurricanes were: primary care, triage, mental health, and home health.

Telehealth has the potential to improve post-disaster access to and coordination of care. However, more information is needed to better understand how telehealth services can be used as a post-disaster health-care delivery tool, particularly for patients receiving care outside of systems such as VA.

This review systematically explores the current available evidence on the effectiveness of interventions provided to first responders to prevent and/or treat the mental health effects of responding to a disaster.

A systematic review of Medline, Scopus, PsycINFO, and gray literature was conducted. Studies describing the effectiveness of interventions provided to first responders to prevent and/or treat the mental health effects of responding to a disaster were included. Quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and the Critical Appraisal Skills Programme (CASP) checklist.

Manuscripts totaling 3869 met the initial search criteria; 25 studies met the criteria for in-depth analysis, including 22 quantitative and 3 qualitative studies; 6 were performed in low- and middle-income countries (LMICs); 18 studies evaluated a psychological intervention; of these, 13 found positive impact, 4 found no impact, and 1 demonstrated worsened symptoms after the intervention. Pre-event trainings decreased psychiatric symptoms in each of the 3 studies evaluating its effectiveness.

This review demonstrates that there are likely effective interventions to both prevent and treat psychiatric symptoms in first responders in high-, medium-, and low-income countries.

The role of medical students in the current coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving. The aim of this review is to explore the involvement of medical students in past global health emergencies, to help inform current and future scenarios.

A rapid systematic review was undertaken, including articles from online databases discussing the roles, willingness and appropriateness of medical student involvement in global health emergencies. Data were extracted, appraised and written up as a narrative synthesis. This study was registered with PROSPERO (CRD42020177231).

Twenty-eight articles were included. Medical students played a wide variety of clinical and nonclinical roles including education and logistics, although medical assistance was the most commonly reported role. Challenges included a lack of preparedness and negative mental health impacts. A total of 91.7% of included articles about willingness found medical students were more willing to be involved than not.

This review shows medical students are capable and willing to be involved in global health emergencies. However, there should be clear protocols for the roles that they play, taking into account the appropriateness. As a rapid review, there were study limitations and more research is required regarding the impact of these roles on medical students and the system.

We launched a health promotion program called the Hamarassen (“let’s get together”) Farm, which provided farming opportunities for the victims of the Great East Japan Earthquake who resided in temporary housing. The aim of this study was to evaluate the effects of this program on physical and mental health in terms of bone mineral density (BMD) and a sense of purpose in life.

Among 39 female participants in whom BMD was evaluated, there were 12 Hamarassen participants, 8 self-farming control subjects, and 19 non-farming control subjects. BMD was measured by calcaneal quantitative ultrasound immediately after the project launch and 5 months later. A sense of purpose in life prior to and 2 months after the project’s commencement was measured in 21 additional Hamarassen participants by use of the K-I Scale. Interviews were also conducted to qualitatively evaluate the effects of the Hamarassen program.

The mean BMD T-score improved by 0.43 in the Hamarassen group, by 0.33 in the self-farming group, and by 0.06 in the controls (p=0.02). Among the 21 Hamarassen participants in whom mental health was evaluated, the average score for a sense of purpose in life improved from 20.5 to 24.9 (p=0.001).

The Hamarassen Farm provided disaster victims with opportunities for social participation, interpersonal interaction, and physical exercise; such opportunities may improve physical and psychosocial well-being. (Disaster Med Public Health Preparedness. 2015;9:103-110)

The novel coronavirus disease 2019 (COVID-19) pandemic has spread to over 213 countries and territories. We sought to describe the clinical features of fatalities in patients with severe COVID-19.

We conducted an Internet-based retrospective cohort study through retrieving the clinical information of 100 COVID-19 deaths from nonduplicating incidental reports in Chinese provincial and other governmental websites between January 23 and March 10, 2020.

Approximately 6 of 10 COVID-19 deaths were males (64.0%). The average age was 70.7 ± 13.5 y, and 84% of patients were elderly (over age 60 y). The mean duration from admission to diagnosis was 2.2 ± 3.8 d (median: 1 d). The mean duration from diagnosis to death was 9.9 ± 7.0 d (median: 9 d). Approximately 3 of 4 cases (76.0%) were complicated by 1 or more chronic diseases, including hypertension (41.0%), diabetes (29.0%) and coronary heart disease (27.0%), respiratory disorders (23.0%), and cerebrovascular disease (12.0%). Fever (46.0%), cough (33.0%), and shortness of breath (9.0%) were the most common first symptoms. Multiple organ failure (67.9%), circulatory failure (20.2%), and respiratory failure (11.9%) are the top 3 direct causes of death.

COVID-19 deaths are mainly elderly and patients with chronic diseases especially cardiovascular disorders and diabetes. Multiple organ failure is the most common direct cause of death.

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)

Exposure to multiple disasters, both natural and technological, is associated with extreme stress and long-term consequences for older adults that are not well understood. In this article, we address age differences in health-related quality of life in older disaster survivors exposed to the 2005 Hurricanes Katrina and Rita and the 2010 BP Deepwater Horizon oil spill and the role played by social engagement in influencing these differences.

Participants were noncoastal residents, current coastal residents, and current coastal fishers who were economically affected by the BP oil spill. Social engagement was estimated on the basis of disruptions in charitable work and social support after the 2005 hurricanes relative to a typical year before the storms. Criterion measures were participants’ responses to the SF-36 Health Survey which includes composite indexes of physical (PCS) and mental (MCS) health.

The results of logistic regressions indicated that age was inversely associated with SF-36 PCS scores. A reduction in perceived social support after Hurricane Katrina was also inversely associated with SF-36 MCS scores.

These results illuminate risk factors that impact well-being among older adults after multiple disasters. Implications of these data for psychological adjustment after multiple disasters are considered. (Disaster Med Public Health Preparedness. 2017;11:90–96)

The Great East Japan Earthquake and tsunami affected approximately 53 000 people in the city of Ishinomaki, Miyagi Prefecture. Approximately 30 000 people were relocated to temporary/rental housing. The remainder re-inhabited tsunami-affected houses, and their conditions were not known. As social isolation could affect physical and psychological health, we investigated the risk of social isolation among the survivors who returned to their homes.

The surveyors went door-to-door to the tsunami-affected houses and interviewed each household between October 2011 and March 2012. The participants’ risk of social isolation was assessed using 3 factors: whether they have (1) friends to talk with about their problems, (2) close neighbors, and (3) social/family interactions. We analyzed the groups at risk of social isolation and identified the related factors.

The elderly (older than age 65 years) were more likely to have close neighbors and social/family interactions, as compared with younger persons. Persons living alone were less likely to have social/family interactions. Non-elderly men who were living alone were the highest proportion of people without social/family interactions.

Our findings suggested that men, particularly those younger than age 65 years and living alone, were at high risk of social isolation and may need attention. (Disaster Med Public Health Preparedness. 2014;0:1-8)

In this investigation, we reported the increase in emergency department and inpatient admission cases during the month of November 2012 post Hurricane Sandy as compared with baseline (November 2010, 2011, and 2013) for elderly patients aged 65 and up.

Medical claims data for patients aged 65 and over treated at emergency department and inpatient health care facilities in New Jersey were analyzed to examine the surge in frequencies of diagnoses treated immediately following Hurricane Sandy. The differences were quantified using gap analysis for 2 years before and 1 year after the event.

There was an average increase of 1700 cases for the month of November 2012 relative to baseline for the top 15 most frequently diagnosed emergency department medical conditions. On a daily basis, a volume increase by an average 57 cases could be expected, including significant numbers of limb fractures and other trauma cases for these most frequently encountered medical conditions.

Understanding the surge level in medical services needed in emergency departments and inpatient facilities during a natural disaster aftermath is critical for effective emergency preparation and response for the elderly population. (Disaster Med Public Health Preparedness. 2018;12:730-738)

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)

Prenatal hurricane exposure may be an increasingly important contributor to poor reproductive health outcomes. In the current literature, mixed associations have been suggested between hurricane exposure and reproductive health outcomes. This may be due, in part, to residual confounding. We assessed the association between hurricane exposure and reproductive health outcomes by using a difference-in-difference analysis technique to control for confounding in a cohort of Florida pregnancies.

We implemented a difference-in-difference analysis to evaluate hurricane weather and reproductive health outcomes including low birth weight, fetal death, and birth rate. The study population for analysis included all Florida pregnancies conceived before or during the 2003 and 2004 hurricane season. Reproductive health data were extracted from vital statistics records from the Florida Department of Health. In 2004, 4 hurricanes (Charley, Frances, Ivan, and Jeanne) made landfall in rapid succession; whereas in 2003, no hurricanes made landfall in Florida.

Overall models using the difference-in-difference analysis showed no association between exposure to hurricane weather and reproductive health.

The inconsistency of the literature on hurricane exposure and reproductive health may be in part due to biases inherent in pre-post or regression-based county-level comparisons. We found no associations between hurricane exposure and reproductive health. (Disaster Med Public Health Preparedness. 2017;11:407–411)

To define and delineate the nontechnical core competencies required for disaster response, Disaster Medical Assistance Team (DMAT) members were interviewed regarding their perspectives and experiences in disaster management. Also explored was the relationship between nontechnical competencies and interprofessional collaboration.

In-depth interviews were conducted with 10 Canadian DMAT members to explore how they viewed nontechnical core competencies and how their experiences influenced their perceptions toward interprofessonalism in disaster response. Data were examined using thematic analysis.

Nontechnical core competencies were categorized under austere skills, interpersonal skills, and cognitive skills. Research participants defined interprofessionalism and discussed the importance of specific nontechnical core competencies to interprofessional collaboration.

The findings of this study established a connection between nontechnical core competencies and interprofessional collaboration in DMAT activities. It also provided preliminary insights into the importance of context in developing an evidence base for competency training in disaster response and management. (Disaster Med Public Health Preparedness. 2013;0:1–8)