Disaster ethics is a developing field of inquiry recognizing the wide variety of ethical issues confronting various professionals involved in planning for and responding to different types of disasters. This article explores how ethical issues related to floods are addressed in academic literature. The review involved analysis of publications on ethics and floods identified in a systematic literature search of electronic databases that included sociological, biomedical, and geophysical sources. The review methods were guided by the PRISMA Statement on systematic reviews, adapted to this topic area, and followed by a qualitative analysis of the included publications. All articles were analyzed using NVivo software version 11. The qualitative analysis showed that further research is needed on the ethical issues involved in flood disasters. Ethical guidelines are needed for flood planners and responders that are based on the consistent application of well-established ethical principles, values, and virtues to the specific circumstances arising with each flood. Flexibility is required in applying such approaches. The results suggest that interdisciplinary collaboration (sociological, biomedical, geophysical, engineering, and ethical) could contribute significantly to the development of ethics in floods. (Disaster Med Public Health Preparedness. 2019;13:817–828)

Background: Neither professional consensus nor evidence exists to guide the choice of essential hospital disaster interventions. The objective of our study was to demonstrate a method for developing consensus on hospital disaster interventions that should be regarded as essential, quantitatively balancing needs and resources.

Methods: A panel of pediatric acute care practitioners developed consensus using a modified Delphi process. Interventions were chosen such that workload per staff member would not exceed the previously validated maximum according to the Therapeutic Intervention Scoring System. Based on published models, it was assumed that the usual numbers of staff would care for a disaster surge of 4 times the usual number of intensive care and non–intensive care hospital patients.

Results: Using a single set of assumptions on constrained resources and overwhelming needs, the panel ranked and agreed on essential interventions. A number of standard interventions would exceed crisis workload constraints, including detailed recording of vital signs and fluid balance, administration of vasoactive agents, invasive monitoring of pressures (central venous, intraarterial, intracranial), dialysis, and tube feedings.

Conclusions: The quantitative methodology and consensus development process described in the present report may have utility in future planning. Groups with appropriate expertise must develop action plans according to authority within each jurisdiction, addressing likely disaster scenarios, according to the needs in each medical service region, using available regional resources, and accounting for the capabilities of each institution. (Disaster Med Public Health Preparedness. 2009;3:27–32)

Objective: To characterize the performance of glucose meter test strips using simulated dynamic temperature and humidity disaster conditions.

Methods: Glucose oxidase- and glucose dehydrogenase-based test strips were dynamically stressed for up to 680 hours using an environmental chamber to simulate conditions during Hurricane Katrina. Paired measurements vs control were obtained using 3 aqueous reagent levels for GMS1 and 2 for GMS2.

Results: Stress affected the performance of GMS1 at level 1 (P <. 01); and GMS2 at both levels (P <. 001), lowering GMS1 results but elevating GMS2 results. Glucose median-paired differences were elevated at both levels on GMS2 after 72 hours. Median-paired differences (stress minus control) were as much as −10 mg/dL (range, −65 to 33) at level 3 with GMS1, with errors as large as 21.9%. Glucose median-paired differences were as high as 5 mg/dL (range, −1 to 10) for level 1 on GMS2, with absolute errors up to 24.4%.

Conclusions: The duration of dynamic stress affected the performance of both GMS1 and GMS2 glucose test strips. Therefore, proper monitoring, handling, and storage of point-of-care (POC) reagents are needed to ensure their integrity and quality of actionable results, thereby minimizing treatment errors in emergency and disaster settings.

(Disaster Med Public Health Preparedness. 2012;6:232–240)

The outbreak of a novel coronavirus, SARS-CoV-2, is challenging international public health and health care efforts. As hospitals work to acquire enough personal protective equipment and brace for potential cases, the role of infection prevention efforts and programs has become increasingly important. Lessons from the 2003 SARS-CoV outbreak in Toronto and 2015 MERS-CoV outbreak in South Korea have unveiled the critical role that hospitals play in outbreaks, especially of novel coronaviruses. Their ability to amplify the spread of disease can rapidly fuel transmission of the disease, and often those failures in infection prevention and general hospital practices contribute to such events. While efforts to enhance infection prevention measures and hospital readiness are underway in the United States, it is important to understand why these programs were not able to maintain continued, sustainable levels of readiness. History has shown that infection prevention programs are primarily responsible for preparing hospitals and responding to biological events but face understaffing and focused efforts defined by administrators. The current US health care system, though, is built upon a series of priorities that often view biopreparedness as a costly endeavor. Awareness of these competing priorities and the challenges that infection prevention programs face when working to maintain biopreparedness is critical in adequately addressing this critical infrastructure in the face of an international outbreak.

The coronavirus disease (COVID-19) pandemic has brought the Italian National Health System to its knees. The abnormally high influx of patients, together with the limited resources available, has forced clinicians to make unprecedented decisions and provide compassionate treatments for which little or no evidence is yet available. This is the case for the use of noninvasive positive pressure ventilation and continuous airway pressure ventilation, combined with prone position in patients with COVID-19 and acute respiratory distress syndrome treated outside of intensive care units. In our article, we comment on the evidence available, so far, and provide a brief summary of data collected at our health institution in Piedmont, Italy.

Russia’s fear of Ukraine becoming a member of the European Union and the North Atlantic Treaty Organization catalyzed the current conflict in Ukraine. The invasion also alarmed other countries, such as Finland and Sweden, who have themselves considered a formal partnership with NATO. Russia’s actions to date have created massive instability and political tensions that uniquely influence the health and socio-political life of civilians in Ukraine and the entire region. The direct and indirect threats of war “gone regional,” “global”, or “nuclear” have energized these countries and their historical alliances to reassess their own socio-political, environmental, and health-care consequences. All countries of the region have clear histories of forced occupation and decades of threats resulting from World War II and its aftermath. The purpose of this rapid communication is 2-fold. First, it discusses the socio-political and health-care consequences of the ongoing Ukrainian conflict in Finland, Russia, Sweden, Poland, and Ukraine. Second, it clarifies the most essential elements of the Hybrid War which cause uniquely distinctive violations of humanitarian laws, treaties, and conventions.

The emergency response to mass casualty incidents in Lebanon lacks uniformity. Three recent large-scale incidents have challenged the existing emergency response process and have raised the need to improve and develop incident management for better resilience in times of crisis. We describe some simple emergency management principles that are currently applied in the United States. These principles can be easily adopted by Lebanon and other developing countries to standardize and improve their emergency response systems using existing infrastructure. (Disaster Med Public Health Preparedness. 2013;0:1–6)

Resilience after a nuclear power plant or other radiation emergency requires response and recovery activities that are appropriately safe, timely, effective, and well organized. Timely informed decisions must be made, and the logic behind them communicated during the evolution of the incident before the final outcome is known. Based on our experiences in Tokyo responding to the Fukushima Daiichi nuclear power plant crisis, we propose a real-time, medical decision model by which to make key health-related decisions that are central drivers to the overall incident management. Using this approach, on-site decision makers empowered to make interim decisions can act without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. Ongoing assessment, consultation, and adaption to the changing conditions and additional information are additional key features. Given the central role of health and medical issues in all disasters, we propose that this medical decision model, which is compatible with the existing US National Response Framework structure, be considered for effective management of complex, large-scale, and large-consequence incidents. (Disaster Med Public Health Preparedness. 2012;0:1-10)

During catastrophic disasters, government leaders must decide how to efficiently and effectively allocate scarce public health and medical resources. The literature about triage decision making at the individual patient level is substantial, and the National Response Framework provides guidance about the distribution of responsibilities between federal and state governments. However, little has been written about the decision-making process of federal leaders in disaster situations when resources are not sufficient to meet the needs of several states simultaneously. We offer an ethical framework and logic model for decision making in such circumstances. We adapted medical triage and the federalism principle to the decision-making process for allocating scarce federal public health and medical resources. We believe that the logic model provides a values-based framework that can inform the gestalt during the iterative decision process used by federal leaders as they allocate scarce resources to states during catastrophic disasters. (Disaster Med Public Health Preparedness. 2014;0:1–10)

This article identifies concepts, trends, and policy gaps in the availability and service delivery of assistive technology utilized by older adults in disasters, as well as implications for emergency management planning and shelter administration. Definitions of types of assistive technology, as well as views of older adults using technology as at-risk individuals for emergency management service provision, are provided. An overview of peer-reviewed articles and gray literature is conducted, focusing on publications from 2001 to the present in the United States. Analytical frameworks used by emergency management organizations as well as regulations such as the Americans with Disabilities Act and recent court decisions on emergency shelter accessibility in disasters are reviewed. Research on the use of assistive technology by older adults during disasters is a neglected issue. The current and potential benefits of defining standards for provision and use of assistive technology for older adults during disasters has received limited recognition in emergency management planning. Older adults with disabilities utilize assistive technology to maintain their independence and dignity, and communities as well as emergency services managers need to become more aware of the needs and preferences of these older adults in their planning processes and drills as well as in service delivery during actual events. (Disaster Med Public Health Preparedness. 2017;11:135–139)

This article applies developing concepts of mass critical care (MCC) to children. In public health emergencies (PHEs), MCC would improve population outcomes by providing lifesaving interventions while delaying less urgent care. If needs exceed resources despite MCC, then rationing would allocate interventions to those most likely to survive with care. Gaps between estimated needs and actual hospital resources are worse for children than adults. Clear identification of pediatric hospitals would facilitate distribution of children according to PHE needs, but all hospitals must prepare to treat some children. Keeping children with a family member and identifying unaccompanied children complicate PHE regional triage. Pediatric critical care experts would teach and supervise supplemental providers. Adapting nearly equivalent equipment compensates for shortages, but there is no substitute for age-appropriate resuscitation masks, IV/suction catheters, endotracheal/gastric/chest tubes. Limitations will be encountered using adult ventilators for infants. Temporary manual bag valve ventilation and development of shared ventilators may prolong survival until the arrival of ventilator stockpiles. To ration MCC to children most likely to survive, the Pediatric Index of Mortality 2 score meets the criteria for validated pediatric mortality predictions. Policymakers must define population outcome goals in regard to lives saved versus life-years saved. (Disaster Med Public Health Preparedness. 2009;3(Suppl 2):S166–S171)