Background: The impact of a natural disaster on self-care and health care delivery has been well documented. The objective of the study was to document the recovery pattern from the impact of a natural disaster such as Hurricane Katrina on clinical and biochemical measures of diabetes and its comorbidities.

Methods: Patients were selected from Tulane University Hospital and Clinic, Southeast Louisiana Veterans Health Care System, and the Medical Center of Louisiana at New Orleans. Adults with diabetes and A1c measurement 6 months before (pre-K) Hurricane Katrina (February 28, 2005–August 27, 2005) and 6 to 16 months after (post-K) Katrina (March 1, 2006–December 31, 2006) were identified within the 3 facilities. Follow-up data (January 1, 2007–December 31, 2007) were 1 year after the first post-K visit. The outcome measures were hemoglobin A1c (HbA1c), systolic and diastolic blood pressure (BP), and lipids (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL], triglycerides).

Results: Averaged across the 3 facilities, the parameters significantly different in the follow-up period compared with pre- and post-K were HbA1c (P = .04), HDL, and systolic and diastolic BP (P < .0001). Parameters with significantly different patterns of change in the 3 facilities over time were HbA1c, HDL, systolic and diastolic BP (P < .0001), and low-density lipoprotein (P < .01).

Conclusions: Our results suggest that a variety of clinical and biochemical parameters related to diabetes and its comorbidities affected by natural disaster have varied the rate of recovery to predisaster levels.

(Disaster Med Public Health Preparedness. 2010;4:S33-S38)

Terrorist incidents that target hospitals magnify morbidity and mortality. Before a real or perceived terrorist mass casualty incident threatens a hospital and its providers, it is essential to have protocols in place to minimize damage to the infrastructure, morbidity, and mortality. In the years following the Boston Marathon bombings, much has been written about the heroic efforts of survivors and responders. Far less has been published about near misses due to lack of experience responding to a mass casualty incident resulting from terrorism. After an extensive review of the medical literature and published media in English, Spanish, and Hebrew, we were unable to identify a similar event. To the best of our knowledge, this is the first reported experience of a bomb threat caused evacuation of an emergency department in the United States while actively responding to multiple casualty terrorist incidents. We summarized the chronology of the events that led to a bomb threat being identified and the subsequent evacuation of the emergency department. We then reviewed the problematic nature of our response and described evidence-based policy changes based on data from health care, law enforcement, and counterterrorism. (Disaster Med Public Health Preparedness. 2019;13:791–798)

On September 13, 2008, Hurricane Ike made landfall in Texas, resulting in the mandatory evacuation of 8 counties before landfall and the declaration of disaster areas in 29 counties afterward. This study evaluated whether Hurricane Ike affected the pattern of Texas poison center calls. Texas poison center calls received from the disaster area counties were identified for 3 time periods: August 12 to September 10, 2008 (preevacuation), September 11 to 13, 2008 (evacuation and hurricane landfall), and September 14 to 30, 2008 (postevacuation). For selected types of calls, the mean daily call volume during time periods 2 and 3 was compared with a baseline range (BR) derived from the mean daily call volume during time period 1. During the evacuation and landfall period, gasoline exposure calls were higher than expected (mean 3, BR −1 to 2). During the postevacuation period, higher than expected numbers of calls were observed for gasoline exposures (mean 5, BR −1 to 2) and carbon monoxide exposures (mean 3, BR –1–1). During an evacuation, certain calls such as those involving gasoline exposures may increase. After a hurricane, calls such as those involving carbon monoxide and gasoline exposures may increase. (Disaster Med Public Health Preparedness. 2009;3:151–157)

In 2017, Cuba was pummeled by Hurricane Irma, one of the strongest and most devastating Atlantic basin hurricanes in history. Twelve of Cuba’s 15 provinces and 90 percent of the population were affected, and there was island-wide loss of electrical power. Despite the significant damage, ongoing economic hardships, and the political realities that required Cuba to handle the situation without response support from other nations, Cuba’s recovery was swift and effective. Cuba’s disaster self-sufficiency and timely response to Hurricane Irma was grounded on 5 decades of disaster planning coupled with ongoing evolution of disaster risk reduction and management strategies. While the central command center, with local dispatch response teams, and mandated citizen engagement are features unique to Cuba’s political structure, in this study, we highlight 5 defining attributes of Cuba’s hurricane response that can constructively inform the actions of other island and coastal nations vulnerable to Atlantic tropical cyclones. These attributes are: (1) actively learning and incorporating lessons from past disaster events, (2) integrating healthcare and public health professionals on the frontlines of disaster response, (3) proactively engaging the public in disaster preparedness, (4) incorporating technology into disaster risk reduction, and (5) infusing science into risk planning. In terms of hurricane response, as a geopolitically isolated nation, Cuba has experienced particular urgency when it comes to protecting the population and creating resilient infrastructure that can be rapidly reactivated after the onslaught of storms of ever-increasing intensity. This includes planning for worsening future disaster scenarios based on a clear-eyed appreciation of the realities of climate change.

The aim of this study was to analyze the impact coronavirus disease 2019 (COVID-19) had in Argentina during its initial stage, identify the measures taken to try to mitigate its impact, and briefly compare it with the influenza A H1N1 pandemic in 2009. This is a descriptive study. Pandemics constitute a serious problem to global health with a major impact on the affected countries’ populations. The recent COVID-19 outbreak represents one of the most important viral pandemics lately. It reached Argentina 64 days after the first case was identified in China. Since then, several measures were taken by the Argentinian government to try to mitigate its impact in this initial stage. An updated report of the current situation and its management in different countries is of vital importance regarding global health issues and may serve for feedback and decision-making.

Background: Terrorism victims comprise the minority among trauma injured people, but this small population imposes a burden on the health care system. Thirty percent of the population injured in terrorist activities experienced severe trauma (injury severity score ≥16), more than half of them need a surgical procedure, and 25% of the population affected by terrorism had been admitted to intensive care. Furthermore, compared with patients with non–terrorism-related trauma, victims of terrorism often arrive in bulk, as part of a mass casualty event. This poses a sudden load on hospital resources and requires special organization and preparedness. The present study compared terrorism-related and road accident–related injuries and examined clinical characteristics of both groups of patients.

Methods: This study is a retrospective study of all patients injured through terrorist acts and road traffic accidents from September 29, 2000 to December 31, 2005, and recorded in the Israel Trauma Registry. Data on the nature of injuries, treatment, and outcome were obtained from the registry. Medical diagnoses were extracted from the registry and classified based on International Classification of Diseases coding. Diagnoses were grouped to body regions, based on the Barell Injury Diagnosis Matrix.

Results: The study includes 2197 patients with terrorism-related injuries and 30,176 patients injured in road traffic accidents. All in all, 27% of terrorism-related casualties suffered severe to critical injuries, comparing to 17% among road traffic accident–related victims. Glasgow Coma Scale scores ≤8, measured in the emergency department, were among 12.3% of terrorism victims, in contrast with 7.4% among people injured on the roads. The terrorism victims had a significantly higher rate of use of intensive care facilities (24.2% vs 12.4%). The overall inpatient death rate was 6.0% among terrorism victims and 2.4% among those injured in road traffic accidents.

Conclusions: Casualties from terrorist events are more severely injured and require more resources relative to casualties from road traffic accidents. (Disaster Med Public Health Preparedness. 2009;3:196–200)

The toll of civilian deaths in current wars and conflicts has been building for decades. Civilian populations, particularly since WWII, have suffered most of the consequences of armed violence and today represent the most at-risk population. This is attributed to the rise of religious and ethnic hatreds, the collapse of State structures, the battle for control of natural resources, the vast availability of weapons, the proliferation of acts of terrorism, and the spread of so-called asymmetric conflicts. Protections provided to innocent civilians under International Humanitarian Law and the Geneva Conventions have been ignored. This commentary captures the experience of the immediate care and transportation provided to military casualties of the Battle of Solferino in 1859 with civilian casualties recently documented in a Stanford-led study during the “golden hour” after injury in 13 conflicts from 1990 to 2017. Despite many advances in triage and management of war injuries over the intervening decades, the common thread of these 2 scenarios is that transport times and early resuscitation capacity and capabilities, first recognized in the 19th century wars and now accepted as global norms and markers for survival from trauma, are as unavailable today to civilians caught up in war and conflict as they were to soldiers in the 19th century.

Background: On June 8 and 9, 2008, more than 4 inches of rain fell in the Iowa-Cedars River Basin causing widespread flooding along the Cedar River in Benton, Linn, Johnson, and Cedar Counties. As a result of the flooding, there were 18 deaths, 106 injuries, and over 38 000 people displaced from their homes; this made it necessary for the Iowa Department of Health to conduct a rapid needs assessment to quantify the scope and effect of the floods on human health.

Methods: In response, the Iowa Department of Public Health mobilized interview teams to conduct rapid needs assessments using Geographic Information Systems (GIS)-based cluster sampling techniques. The information gathered was subsequently employed to estimate the public health impact and significant human needs that resulted from the flooding.

Results: While these assessments did not reveal significant levels of acute injuries resulting from the flood, they did show that many households had been temporarily displaced and that future health risks may emerge as the result of inadequate access to prescription medications or the presence of environmental health hazards.

Conclusions: This exercise highlights the need for improved risk communication measures and ongoing surveillance and relief measures. It also demonstrates the utility of rapid needs assessment survey tools and suggests that increasing use of such surveys can have significant public health benefits.

(Disaster Med Public Health Preparedness. 2011;5:287–292)

Objective: To study when and how an urgent public health message about a boil-water order reached an urban population after the Massachusetts water main break.

Methods: In-person surveys were conducted in waiting areas of clinics and emergency departments at a large urban safety net hospital within 1 week of the event.

Results: Of 533 respondents, 97% were aware of the order; 34% of those who lived in affected cities or towns were potentially exposed to contaminated water. Among those who were aware, 98% took action. Respondents first received the message through word of mouth (33%), television (25%), cellular telephone calls (20%), landline calls (10%), and other modes of communication (12%). In multivariate analyses, foreign-born respondents and those who lived outside the city of Boston had a higher risk of exposure to contaminated water. New modes (eg, cellular telephones) were used more commonly by females and younger individuals (ages 18 to 34). Individuals who did not speak English at home were more likely to receive the message through their personal networks.

Conclusions: Given the increasing prevalence of cellular telephone use, public officials should encourage residents to register landline and cellular telephone for emergency alerts and must develop creative ways to reach immigrants and non–English-speaking groups quickly via personal networks.

(Disaster Med Public Health Preparedness. 2011;5:235–241)

The current coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) pandemic has resulted in severe shortages of personal protective equipment, including respiratory protective equipment, such as N95 respirators. This has led some government agencies to suggest the use of cloth face coverings (CFCs) by health-care providers and the general public as a last resort when standard respiratory protective equipment is unavailable. Although such coverings have been in use for over a century and have found widespread use during some previous pandemics, research data are relatively scant for the protective value of this measure. This article, a literature review, explores the development of CFCs and reviews available scientific research regarding the efficacy of this intervention as a preventive measure in the spread of airborne infectious diseases

We propose a stochastic programming model as a solution for optimizing the problem of locating and allocating medical supplies used in disaster management. To prepare for natural disasters, we developed a stochastic optimization approach to select the storage location of medical supplies and determine their inventory levels and to allocate each type of medical supply. Our model also captures disaster elaborations and possible effects of disasters by using a new classification for major earthquake scenarios. We present a case study for our model for the preparedness phase. As a case study, we applied our model to earthquake planning in Adana, Turkey. The experimental evaluations showed that the model is robust and effective. (Disaster Med Public Health Preparedness. 2017;11:747–755)

A systematic literature review on quantitative methods to assess community resilience was conducted following Institute of Medicine and Patient-Centered Outcomes Research Institute standards. Community resilience is the ability of a community to bounce back or return to normal after a disaster strikes, yet there is no agreement on what this actually means. All studies reviewed addressed natural disasters, but the methodological approaches can be applied to technological disasters, epidemics, and terrorist attacks. Theoretical frameworks consider the association between vulnerability, resilience, and preparedness, yet these associations vary across frameworks. Because of this complexity, indexes based on composite indicators are the predominant methodological tool used to assess community resilience. Indexes identify similar dimensions but observe resilience at both the individual and geographical levels, reflecting a lack of agreement on what constitutes a community. A consistent, cross-disciplinary metric for community resilience would allow for identifying areas to apply short-term versus long-term interventions. A comparable metric for assessing geographic units in multiple levels and dimensions is an opportunity to identify regional strengths and weaknesses, develop timely targeted policy interventions, improve policy evaluation instruments, and grant allocation formulas design. (Disaster Med Public Health Preparedness. 2017;11:756–763)