On March 11, 2011, Japan experienced the largest earthquake in its history. The undersea earthquake launched a tsunami that inundated much of Japan's eastern coastline and damaged nuclear power plants, precipitating multiple reactor meltdowns. We examined open-source disaster situation reports, news accounts, and disaster-monitoring websites to gather event-specific data to conduct a trauma signature analysis of the event.

The trauma signature analysis included a review of disaster situation reports; the construction of a hazard profile for the earthquake, tsunami, and radiation threats; enumeration of disaster stressors by disaster phase; identification of salient evidence-based psychological risk factors; summation of the trauma signature based on exposure to hazards, loss, and change; and review of the mental health and psychosocial support responses in relation to the analysis.

Exposure to this triple-hazard event resulted in extensive damage, significant loss of life, and massive population displacement. Many citizens were exposed to multiple hazards. The extremity of these exposures was partially mitigated by Japan's timely, expert-coordinated, and unified activation of an evidence-based mental health response.

The eastern Japan disaster was notable for its unique constellation of compounding exposures. Examination of the trauma signature of this event provided insights and guidance regarding optimal mental health and psychosocial responses. Japan orchestrated a model response that reinforced community resilience. (Disaster Med Public Health Preparedness. 2013;0:1-14)

This study aims to assess the perception and attitude of emergency medical services (EMS) providers toward working during disease outbreaks, and the factors that may influence their decisions to ultimately work or not.

This is a cross-sectional study assessing the attitude of EMS providers to work during disease outbreaks. Descriptive statistics and regression analyses were performed to assess attitudes toward reporting for duty and factors that influence providers’ decisions.

Of the 500 surveys distributed, 466 (93.2%) were complete and included for analysis. The majority of participants (70.2%) are male with a mean age of 27 (SD 4.3) years. The study found that the majority (71.1%) of participants are willing to come to work during disease outbreaks. The study found 7 predictors of reporting for duty. Confidence that employer will provide adequate protective gear was the most significant predictor (odds ratio [OR], 3.95; 95% confidence interval [CI] = 2.31-5.42). Concern for family safety was the most important barrier against coming to work (OR, 0.40; 95% CI = 0.21-0.73).

Providing adequate supplies of protective gear along with knowledge and training for disease outbreak are the main factors that enhance providers to fulfill their work expectations.

To analyze the development of disaster medicine and to identify the main obstacles to improving disaster medicine research and application.

A topic search strategy was used to search the Web of Science Core Collection database. The 100 articles with the highest local citation scores were selected for bibliometric analysis; summarizing informetric indicators; and preparing a historiography, themes network, and key word co-occurrence map.

The 100 articles with the highest local citation scores were published from 1983 to 2013 in 9 countries, mainly in the United States. The most productive authors were Koenig and Rubinson. The lead research institution was Columbia University. The most commonly cited journal was the Annals of Emergency Medicine. The development of disaster medicine could be separated into 3 consecutive periods. All results indicate that the development of disaster medicine faces some obstacles that need to be addressed.

Research works have provided a solid foundation for disaster medicine, but its development has been in a slow growth period for a long time. Obstacles to the development of disaster medicine include the lack of scientist communities, transdisciplinary research, innovative research perspectives, and continuous research. Future research should overcome these obstacles so as to make further advances in this field.

Strong earthquakes have been reported to increase the incidence of diseases. One reason for these increases may be the stress from the poor living environment for evacuees in disaster shelters. To reduce stress, makeshift cardboard beds were introduced in shelters in the Ishinomaki region, one of the areas heavily damaged by the Great East Japan Earthquake, 4 months after the earthquake. The study was performed to determine whether use of the beds offered a reduction in the disease burden.

Blood pressure and blood D-dimer values, often used as diagnostic tests for venous thrombosis, were checked. The timed Up & Go (TUG) test, which assesses functional mobility; a questionnaire survey about symptoms (cough, insomnia, and lumbago); and an SF-8 health survey, a health-related quality of life survey, were also administered before and 1 month after introducing the beds.

Blood pressure measurements, TUG test results, and questionnaire survey scores improved significantly 1 month after the introduction of the beds. Also, evacuees with higher blood D-dimer values tended to show improvement, suggesting that the beds may have had a good effect on persons with underlying venous thrombotic disorders.

Makeshift beds of cardboard could be very useful in disaster shelters. (Disaster Med Public Health Preparedness. 2013;7:573–577)

Since 2003, the Chinese National Health and Family Planning Commission (formerly the Ministry of Health) has implemented changes to more effectively communicate risk during public health emergencies. In spite of ongoing improvements, provincial and sub-provincial leaders face barriers, such as established modes of operation, lack of training, shortage of trained risk communicators, and limited understanding and willingness of recipients to mitigate risks.

We assessed the current status of and barriers to risk communication knowledge and practice among public health practitioners in China. We designed the survey questionnaire to capture information related to the risk communication core capacities required by international health regulations and common risk communication principles.

Our findings showed that risk communication training has successfully developed an awareness of risk communication principles and the ability to implement those principles in practice in China.

Future efforts should focus on areas such as a dedicated risk communication workforce, requirements that public health agencies develop a risk communication plan, and additional training for public health practitioners and their partners. It is critical that the infectious diseases prevention and control law be amended to grant provincial and local public health agencies more autonomy to release information. (Disaster Med Public Health Preparedness. 2014;0:1-7)

To assess the preparedness of the US mass fatality infrastructure, we developed and tested metrics for 3 components of preparedness: organizational, operational, and resource sharing networks.

In 2014, data were collected from 5 response sectors: medical examiners and coroners, the death care industry, health departments, faith-based organizations, and offices of emergency management. Scores were calculated within and across sectors and a weighted score was developed for the infrastructure.

A total of 879 respondents reported highly variable organizational capabilities: 15% had responded to a mass fatality incident (MFI); 42% reported staff trained for an MFI, but only 27% for an MFI involving hazardous contaminants. Respondents estimated that 75% of their staff would be willing and able to respond, but only 53% if contaminants were involved. Most perceived their organization as somewhat prepared, but 13% indicated “not at all.” Operational capability scores ranged from 33% (death care industry) to 77% (offices of emergency management). Network capability analysis found that only 42% of possible reciprocal relationships between resource-sharing partners were present. The cross-sector composite score was 51%; that is, half the key capabilities for preparedness were in place.

The sectors in the US mass fatality infrastructure report suboptimal capability to respond. National leadership is needed to ensure sector-specific and infrastructure-wide preparedness for a large-scale MFI. (Disaster Med Public Health Preparedness. 2016;10:87–97)

Disasters occur without warning and can have devastating consequences. Emergency preparedness can reduce negative effects. It is especially important that parents prepare, as children are particularly vulnerable after disasters. This study tested 2 hypotheses: (1) adults with more children are likely to be better prepared than those with fewer or no children because greater caretaking is linked to greater perceived threat of disaster leading to greater preparedness and (2) the strength of this mediational link varies as a function of parental self-efficacy.

Data from an online survey about human-made disasters (terrorism) with a community convenience sample were used to test the hypothesis that perceived threat mediates the relationship between parental status (number of children cared for) and preparedness behaviors, moderated by level of self-efficacy for emergency preparedness.

A bootstrapping analysis with relevant covariates supported the hypothesized mediating effect of threat on the relationship between parental status and preparedness. This relationship was strengthened at higher levels of parental preparedness self-efficacy.

The results of this study are particularly relevant for preparedness interventions. Because threat leads to preparedness, particularly for parents with high self-efficacy, it is important to focus attention on factors that can improve parents’ sense of self-efficacy. (Disaster Med Public Health Preparedness. 2018; 12: 345–351)

In this study, we carried out a text analysis on the information disseminated and discussed among netizens on the Baidu Post Bar (the world’s largest Chinese forum) during the coronavirus disease 2019 (COVID-19) epidemic, to create a policy basis for health administrative departments.

We used Python tools to search for the relevant data on the Baidu Post Bar. Next, a text analysis was performed on the posts’ contents using a combination of latent Dirichlet allocation (LDA), sentiment analysis, and correlation analysis.

According to the LDA analysis, the public was highly interested in topics such as COVID-19 prevention, infection symptoms, infection and coping measures, sources of transmission and treatments, community management, and work resumption. The majority of the public had negative emotional values, yet a portion of the public held positive emotional values. We also performed a correlation analysis of the influencing factors was established.

Netizens’ degree of concern shown in their posts was greatly associated with the spread of COVID-19. With the rise, diffusion, outbreak, and mitigation of COVID-19 in China, netizens have successively created a large number of posts, and the topics of discussion varied over time. Therefore, the media and the government have the responsibility to distribute positive information, to correctly guide the public’s emotions to bring some sort of reassurance to the public.

We examined public perceptions of the risk of an Ebola outbreak, knowledge about transmission, and the factors associated with planned protective behavior, including willingness to vaccinate.

We conducted a cross-sectional telephone survey using random digit dialing of 750 members of the New Zealand public between February 12 and 19, 2015.

Most of the sample (72%) reported that they had been following news of the outbreak closely and 28% were concerned that there would be a large outbreak in New Zealand. High rates of planned protective behavior, in terms of avoiding contact with other people, were reported, with 23% reporting they would avoid going to work, 49% reporting they would avoid using public transport, 42% reporting they would avoid sending children to school, and 52% reporting they would avoid public events. A younger age, a higher concern, and lower confidence in the ability of hospitals to contain the outbreak were significantly associated with both a greater willingness to vaccinate and a larger number of protective behaviors.

An Ebola outbreak would have large social and economic consequences owing to the large proportion of the population who intended to avoid social contact in order to protect their health. (Disaster Med Public Health Preparedness. 2016;10:674–680)

Our knowledge about the impact of coping behavior styles in people exposed to stressful disaster events is limited. Effective coping behavior has been shown to be a psychosocial stress modifier in both occupational and nonoccupational settings.

Data were collected by using a web-based survey that administered the Post-Traumatic Stress Disorder (PTSD) Checklist–Civilian, General Coping Questionnaire-30, and a supplementary questionnaire assessing various risk factors. Logistic regression models were used to test for the association of the 3 coping styles with probable PTSD following disaster exposure among federal disaster responders.

In this sample of 549 study subjects, avoidant coping behavior was most associated with probable PTSD. In tested regression models, the odds ratios ranged from 1.19 to 1.26 and 95% confidence intervals ranged from 1.08 to 1.35. With control for various predictors, emotion-based coping behavior was also found to be associated with probable PTSD (odds ratio=1.11; 95% confidence interval: 1.01-1.22).

This study found that in disaster responders exposed to traumatic disaster events, the likelihood of probable PTSD can be influenced by individual coping behavior style and other covariates. The continued probability of disasters underscores the critical importance of these findings both in terms of guiding mental health practitioners in treating exposed disaster responders and in stimulating future research. (Disaster Med Public Health Preparedness. 2016;10:108–117)

The 2015 earthquake in Nepal affected the country in terms of economy, and by causing damage and stress reactions. This study aimed to estimate the prevalence and determine individual child- and family-level predictors of post-traumatic stress disorder (PTSD) symptoms.

A community-based cross-sectional study was carried out in Kathmandu district 15 months after the earthquake. Multistage cluster sampling was adopted to collect 800 earthquake-affected children aged 7-16 years and a face-to-face interview was conducted. Trauma exposure questionnaire and Child PTSD Symptoms Scale were used for assessment of the level of exposure and PTSD symptoms. Multilevel generalized linear regression analysis was used to explore individual and family-level predictors.

Among the children, 51% had moderate-to-severe PTSD symptoms. Children of school age (adjusted odds ratio=2.83 [1.45-5.49]), those attending lower-secondary school (2.26 [1.21-4.21]), those having a higher exposure to the severity of the earthquake, and those with low psychosocial acuity [1.70 (1.10-2.60)] were more likely to have more severe PTSD symptoms compared with those who were adolescents and in higher-secondary school, whereas children from a family living in an urban (0.33 [0.19-0.59]) setting and following Hindu religion (0.31 [0.16-0.60]) were less likely to have PTSD symptoms compared with children from suburban areas and those following Buddhist religion.

PTSD symptoms were prevalent among children of Nepal more than a year following the earthquake. Family-level indicators cannot be excluded when studying children’s trauma reactions. (Disaster Med Public Health Preparedness. 2018;12:486–492)

We aimed to evaluate the occurrence of work-related injuries after Hurricane Sandy potentially related to response and recovery.

Emergency and hospital discharges (patients aged 18-65 years) with a diagnosis of unintentional injury were obtained from the New Jersey Department of Health. Work-related injuries were identified as those with a workers’ compensation payer or other work-related codes. Counties were categorized as high-, medium-, or low-impact areas. Poisson regression analysis was used to compare the rate of work-related injury the year following Sandy landfall with the 3 previous years.

Total work-related injuries declined the week immediately after Sandy (rate ratio [RR]: 0.85; 95% confidence interval [CI]: 0.69-1.05) and no overall increase was found in the year after Hurricane Sandy. However, high-impact counties showed an elevated risk of work-related injuries in the first and third quarters after Hurricane Sandy among men, especially for blacks and Hispanics. The greatest excesses occurred in the third quarter after the storm, May to July, for falls (RR: 1.30; 95% CI: 1.08-1.57), cut/pierce injuries (RR: 1.24; 95% CI: 1.09-1.40), struck-by injuries (RR: 1.17; 95% CI: 1.02-1.34), and overexertion (RR: 1.26; 95% CI: 1.10-1.44).

Hospital data suggested an increase in injuries associated with rebuilding and recovery rather than with initial response. Future efforts aimed at prevention should evaluate the mechanisms and circumstances of injury in more detail. (Disaster Med Public Health Preparedness. 2016;10:394–404)

The purpose of this study was to examine the associations between oil spill exposure, trauma history, and behavioral health 6 years after the Deepwater Horizon oil spill (DHOS). We hypothesized that prior trauma would exacerbate the relationship between oil spill exposure and behavioral health problems.

The sample included 2,520 randomly selected adults in coastal areas along the Gulf of Mexico. Participants reported their level of oil spill exposure, trauma history, depression, anxiety/worry, illness anxiety, and alcohol use.

Individuals with more traumatic experiences had a significantly higher risk for all measured behavioral health problems after controlling for demographic factors and DHOS exposure. Those with higher levels of DHOS exposure were not at greater risk for behavioral health problems after controlling for prior trauma, with the exception of illness anxiety. There was no evidence that trauma history moderated the association between DHOS exposure and behavioral health.

Findings suggest that trauma exposure may be a better indicator of long-term behavioral health risk than DHOS exposure among disaster-prone Gulf Coast residents. DHOS exposure may be a risk factor for illness anxiety but not more general behavioral health concerns. Trauma history did not appear to exacerbate risk for behavioral health problems among Gulf residents exposed to the DHOS. (Disaster Med Public Health Preparedness. 2019;13:497-503)

This study compared the prognostic performances of the Brescia-COVID Respiratory Severity Scale (BCRSS) and the Quick COVID-19 Severity Index (qCSI) scores in hospitalized patients diagnosed with COVID-19.

The data of all adult patients (over 18 y of age) who were admitted into a state hospital with confirmed COVID-19 between May 1, 2020, and October 31, 2020, were retrospectively examined. The area under the receiver operating characteristic (ROC) curve, known as the area under the curve (AUC), was used to assess the BCRSS prediction rule and the qCSI score to assess the discriminatory power in predicting in-hospital mortality and intensive care unit (ICU) admission.

There were 341 patients included in this study. The mean age of the patients was 58.2 ± 17.2, of which 165 were men and 176 were women, and 61.3% of patients had at least 1 comorbidity. The most common comorbidity was hypertension. The predictive power scores of BCRSS and qCSI were found as very good in terms of in-hospital mortality (AUC 0.804 and 0.847, respectively) and likewise in terms of ICU admission (AUC 0.842 and 0.851, respectively).

Both BCRSS and qCSI scoring systems were found to be successful in predicting in-hospital mortality and ICU admission in our patient population.