To determine the ability of a novel responder mental health self-triage system to predict post-traumatic stress disorder (PTSD) in emergency medical responders after a disaster.

Participants in this study responded to Typhoon Haiyan, which struck the Philippines in November 2013. They completed the Psychological Simple Triage and Rapid Treatment (PsySTART) responder triage tool, the PTSD Checklist (PCL-5) and the Patient Health Questionnaire-8 (PHQ-8) shortly after responding to this disaster. The relationships between these 3 tools were compared to determine the association between different risk exposures while providing disaster medical care and subsequent levels of PTSD or depression.

The total number of PsySTART responder risk factors was closely related to PCL-5 scores ≥38, the threshold for clinical PTSD. Several of the PsySTART risk factors were predictive of clinical levels of PTSD as measured by the PCL-5 in this sample of deployed emergency medical responders.

The presence of a critical number and type of PsySTART responder self-triage risk factors predicted clinical levels of PTSD and subclinical depression in this sample of emergency medical workers. The ability to identify these disorders early can help categorize an at-risk subset for further timely “stepped care” interventions with the goals of both mitigating the long-term consequences and maximizing the return to resilience. (Disaster Med Public Health Preparedness. 2018;12:19–22)

Personal protective equipment (PPE) use is frequently construed as inconvenient and disturbing by health care professionals (HCPs). We hypothesized that new-onset symptoms among HCPs may be associated with extended use of PPE and aimed to investigate risk factors related with new-onset symptoms. In addition, the effects of new-onset symptoms on working performance were evaluated.

In this cross-sectional study, 315 participants filled out a questionnaire that contains 4 main parts: (1) demographics, (2) new-onset symptoms with PPE use, (3) PPE usage hours, and (4) personal opinion about the effect of sensed symptoms on working performance.

The mean age was 31.58 ± 4.6 years, and 50.5% (n = 159) were female. New-onset symptom rate was 66% (n = 208). The most common new-onset symptom was headache (n = 115, 36.5%) followed by breathing difficulty-palpitation (n = 79, 25.1%), and dermatitis (n = 64, 20.3%). Extended use of PPE, smoking, and overweight were independently associated with developing new-onset symptoms. A clear majority of symptomatic participants pointed out the impact on working performance (193/208, 92.7%).

Hospitals should take the necessary precautions (eg, shorter shifts and more frequent breaks) to prevent symptoms associated with PPE and ensure that HCPs comply with these precautions.

We aimed to compare access to gynecologic oncology care at a private and a city hospital, both of which closed for a period of time because of Hurricane Sandy.

This was a cross-sectional study of gynecologic oncology chemotherapy, radiotherapy, and surgical patients from October 29, 2012 (the eve of the storm), to February 7, 2013 (the reopening of the city hospital). New referrals during this time were excluded. Delays in chemotherapy, radiotherapy, and surgery were compared.

Analysis included 113 patients: 59 private patients (52.2%) and 54 city patients (47.8%). Of the private patients, 33/59 received chemotherapy (55.9%), 1/59 received radiotherapy (1.7%), and 28/59 had planned surgery (47.5%). Of the city patients, 40/54 received chemotherapy (74.1%), 7/54 received radiotherapy (12.3%), and 18/54 had planned surgery (33.3%). The mean delay in chemotherapy was 7.6 days at the private hospital and 21.7 days at the city hospital (P=0.0004). The mean delay in scheduled surgery was 14.2 days at the private hospital and 22.7 days at the city hospital (P=0.3979). The mean delay in radiotherapy was 0.0 days at the private hospital and 25.0 days at the city hospital (P=0.0046). Loss to follow-up rates were 3/59 of the private patients (5.1%) and 3/54 of the city patients (5.6%).

Gynecologic oncology care was maintained during a natural disaster despite temporary closure and relocation of services. Disparity in care was in access to chemotherapy. (Disaster Med Public Health Preparedness. 2015;9:605–608)

Literature explores which factors most impact resilience and how these factors impact an individual and communities’ ability to cope with disaster. Less research has focused on how age impacts resilience. This research adapts several previous conceptual models used to investigate resilience. To investigate the unique vulnerabilities faced by older individuals in post-disaster settings, this analysis was undertaken to investigate predictors of individual resilience.

Data for the study were derived from the Centers for Disease Control and Prevention (CDC) Gulf States Population Survey (GSPS). The final sample included 5,713 adult residents from 4 gulf-coast states. Multiple linear regression was used for the analysis.

All models (demographic, health, social, and combined) acted as significant predictors of individual resilience. Health and social resilience models accounted for more of the variance in resilience scores. In all models, age was negatively associated with resilience scores. Being female was protective across all models. The results of the model testing indicate inequitable disaster mitigation, with social and health indicators explaining the most variance in the resilience levels.

This research provides practitioners with the knowledge they need to focus their interventions on the areas where it is most needed to empower resilient individuals. (Disaster Med Public Health Preparedness. 2019;13:256–264)

It is unclear which pediatric disaster triage (PDT) strategy yields the best accuracy or best patient outcomes.

We conducted a cross-sectional analysis on a sample of emergency medical services providers from a prospective cohort study comparing the accuracy and triage outcomes for 2 PDT strategies (Smart and JumpSTART) and clinical decision-making (CDM) with no algorithm. Participants were divided into cohorts by triage strategy. We presented 10-victim, multi-modal disaster simulations. A Delphi method determined patients’ expected triage levels. We compared triage accuracy overall and for each triage level (RED/Immediate, YELLOW/Delayed, GREEN/Ambulatory, BLACK/Deceased).

There were 273 participants (71 JumpSTART, 122 Smart, and 81 CDM). There was no significant difference between Smart triage and CDM. When JumpSTART triage was used, there was greater accuracy than with either Smart (P<0.001; OR [odds ratio]: 2.03; interquartile range [IQR]: 1.30, 3.17) or CDM (P=0.02; OR: 1.76; IQR: 1.10, 2.82). JumpSTART outperformed Smart for RED patients (P=0.05; OR: 1.48; IQR: 1.01,2.17), and outperformed both Smart (P<0.001; OR: 3.22; IQR: 1.78,5.88) and CDM (P<0.001; OR: 2.86; IQR: 1.53,5.26) for YELLOW patients. Furthermore, JumpSTART outperformed CDM for BLACK patients (P=0.01; OR: 5.55; IQR: 1.47, 20.0).

Our simulation-based comparison suggested that JumpSTART triage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM. (Disaster Med Public Health Preparedness. 2016;10:253–260)

Women and men might experience psychological distress differently during a disaster. This study investigated gender differences in the factors associated with psychological distress among working-age people 1 to 2 years after the Great East Japan Earthquake.

A cross-sectional household survey of victims who remained living in their homes was conducted between May and December 2012 in Ishinomaki City, Japan. Psychological distress was defined as a Kessler Psychological Distress Scale ≥5, and gender differences were examined using a logistic regression analysis.

Data were obtained from 2593 individuals, and 1537 participants were included in the analyses. Psychological distress was observed in 28.0% of the participants. Living in a household without a salaried income and a low frequency of leaving the house were associated with psychological distress among women. Young age, lack of occupation and no informational support were associated with psychological distress among men. Income change due to the disaster and health complaints were associated with psychological distress in both genders.

For women, stable household income and frequently leaving the house can be protective factors. For men, intervention focusing on young people, occupational support, and informational support may be useful. Income change after the disaster and health complaints may be risk factors in both genders. (Disaster Med Public Health Preparedness. 2019;13:487-496)

This study explored the influence of satisfaction with economic and social rights (ESR) on the quality of life (QOL) of people in post-disaster zones in Sichuan, China.

Data from a survey conducted in 2013 in the 5 hardest hit counties in the earthquake-prone area of Sichuan were used. QOL was measured by use of the brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). Structural equation models were developed to determine the specific features of the influence of satisfaction with ESR on QOL.

The mean values of both the WHOQOL-BREF scale and the ESR satisfaction scale were lower than the midpoint of the scales. Satisfaction with ESR had a significant effect on psychological health, social relationships, and environment, apart from physical health. Satisfaction with the right to food had the greatest effect on QOL, followed by the rights to education, work, health, social security, and housing.

Satisfaction with ESR had a significant positive influence on the QOL of people in a post-disaster zone, particularly satisfaction with the right to food. Policies on food and education guarantees and mental health intervention are highlighted. (Disaster Med Public Health Preparedness. 2015;9:111-118)

In South Korea, many individuals were self-quarantined for the coronavirus disease 2019 (COVID-19) after the quarantine criteria were extended to all overseas travelers. This study was conducted to identify the noncompliance rate of self-quarantine for COVID-19 cases and assess the impact of a 1-strike out policy and an increased amount of penalty for the violating self-quarantine in South Korea.

The self-quarantine noncompliance rate for COVID-19 was examined using publicly available data. We collected the daily number of quarantine and quarantine violation cases from March 22 to June 10, 2020. A Poisson regression analysis was conducted to identify the impact of additional sanctions for the quarantine violation.

The median number of individuals quarantined per day was 36,561 (interquartile range, 34,408-41,961). The median number of daily self-quarantine violations was 6 (range, 0-13). The median rate of self-quarantine violations was 1.6 per 10,000 self-quarantined individuals (range, 0.0-8.0 per 10,000 self-quarantined individuals). The additional sanction has no significant impact on the number of violations among quarantine individuals (P = 0.99).

The additional sanction for the violation of quarantined individuals did not reduce the self-quarantine violations. Further studies are warranted to strengthen the compliance of self-quarantine for future pandemics.

We sought to elucidate news article reporting of adverse public psychosocial behaviors, in particular, rumor-related coverage (eg, panic, demagoguery) and exclusive behavior coverage (negative behaviors, eg, discrimination, bullying) during the 2009 influenza A (H1N1) influenza pandemic in Japan.

We examined 154 Internet news-site articles reporting adverse public psychosocial responses in the first 60 days of the outbreak. Rumor-related coverage and exclusive behavior coverage were dichotomously coded as included or not. Moreover, we assessed whether or not health information (eg, coping methods, virus toxicity information) or emphasis on information quality (eg, importance of information, cautions about overreactions) were simultaneously reported.

Rumor-related coverage (n=120, 77.9%) was less likely to simultaneously report public health information (eg, toxicity information, health support information, and cautions about overreactions; P<.05). Conversely, exclusive behavior coverage (n=41, 26.6%) was more likely to report public health information (P<.05).

Rumor-related coverage was less likely to have accompanying public health information, whereas exclusive behavior coverage was more likely to include it. During public health crises, it is essential to understand that rumors and exclusive behaviors have adverse effects on the public and that accompanying public health information may help people take proactive coping actions. (Disaster Med Public Health Preparedness. 2015;9:459–463)

Psychological distress is a common symptom after natural disasters. Although musculoskeletal pain also increases after natural disasters, its relation to psychological distress is not known. This study aimed to examine the association of musculoskeletal pain with new-onset psychological distress among survivors of the Great East Japan Earthquake.

A panel study was conducted with survivors at 2 and 3 years after the Great East Japan Earthquake. New-onset psychological distress was defined as psychological distress absent at 2 years and present at 3 years after the disaster. The number of musculoskeletal pain sites at 2 years after the disaster was divided into 3 categories (0, 1, and ≥2). Multivariate logistic regression models were used to calculate the odds ratio and 95% confidence interval for new-onset psychological distress according to the number of musculoskeletal pain sites.

The rate of new-onset psychological distress was 6.7%. Musculoskeletal pain was associated with new-onset psychological distress. Using “0” as a reference, the adjusted odds ratios (95% confidence interval) were 1.65 (0.92-2.95) in “1” and 2.12 (1.24-3.64) in “≥2” (P for trend=.02).

Musculoskeletal pain is associated with new-onset psychological distress among survivors of the Great East Japan Earthquake. (Disaster Med Public Health Preparedness. 2019;13:295–300)

In a population with prior exposure to the World Trade Center (WTC) disaster, this study sought to determine the relationship between Hurricane Sandy-related inhalation exposures and post-Sandy lower respiratory symptoms (LRS).

Participants included 3835 WTC Health Registry enrollees who completed Wave 3 (2011-2012) and Hurricane Sandy (2013) surveys. The Sandy-related inhalational exposures examined were: (1) reconstruction exposure; (2) mold or damp environment exposure; and (3) other respiratory irritants exposure. LRS were defined as wheezing, persistent cough, or shortness of breath reported on ≥1 of the 30 days preceding survey completion. Associations between LRS and Sandy exposures, controlling for socio-demographic factors, post-traumatic stress disorder, and previously reported LRS and asthma were examined using multiple logistic regression.

Over one-third of participants (34.4%) reported post-Sandy LRS. Each of the individual exposures was also independently associated with post-Sandy LRS, each having approximately twice the odds of having post-Sandy LRS. We found a dose-response relationship between the number of types of Sandy-related exposures reported and post-Sandy LRS.

This study provides evidence that post-hurricane clean-up and reconstruction exposures can increase the risk for LRS. Public health interventions should emphasize the importance of safe remediation practices and recommend use of personal protective equipment. (Disaster Med Public Health Preparedness. 2018;12:697-702)

The study provides a comprehensive insight into how an initial receiving hospital without adequate capacity adapted to coping with a mass casualty incident after the Formosa Fun Coast Dust Explosion (FFCDE).

Data collection was via in-depth interviews with 11 key participants. This was combined with information from medical records of FFCDE patients and admission logs from the emergency department (ED) to build a detailed timeline of patients flow and ED workload changes. Process tracing analysis focused on how the ED and other units adapted to coping with the difficulties created by the patient surge.

The hospital treated 30 victims with 36.3% average total body surface area burn for over 5 hours alongside 35 non-FFCDE patients. Overwhelming demand resulted in the saturation of ED space and intensive care unit beds, exhaustion of critical materials, and near-saturation of clinicians. The hospital reconfigured human and physical resources differently from conventional drills. Graphical timelines illustrate anticipatory or reactive adaptations. The hospital’s ability to adapt was based on anticipation during uncertainty and coordination across roles and units to keep pace with varying demands.

Adapting to beyond-surge capacity incident is essential to effective disaster response. Building organizational support for effective adaptation is critical for disaster planning.

The coronavirus disease (COVID-19) pandemic has somehow affected the lives of 80% of the world’s population. Iran has also experienced numerous outbreaks of this disease. The fifth wave having occurred in August 2021 was one of the most agonizing incidences of the pandemic in the country.

We reviewed all of publications and govermental statistics about COVID-19 pandemic In Iran between 2019 to 2021.

The current study discusses the possible dimensions and causes of successive waves of COVID-19 in Iran, namely, the consequences of a significant delay in vaccination administration in due time, the collective overwhelming fallacy toward immunization, the polypharmacy controversy, inadequate community-based participation in risk reduction, and noticeable decrease in the public’s resilience.

A variety of strategies have been recommended in the article to modify the principal challenges in order to help control the pandemic in the country.

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)