The aim of this study was to investigate the opinions of different groups of people in Iran on their willingness to receive a coronavirus disease 2019 (COVID-19) vaccine.

In this cross-sectional study, we surveyed a sample (based on consecutive referrals) of 5 groups of people in late 2020: a group of the general population from Shiraz (without a history of any chronic medical or psychiatric problems), patients with epilepsy, patients with diabetes mellitus (DM), patients with cardiac problems, and patients with psychiatric problems. The survey included 4 general questions and 3 COVID-19–specific questions.

A total of 582 people participated. In total, 66 (11.3%) people expressed that they were not willing to receive a COVID-19 vaccine. Psychiatric disorders (odds ratio [OR]: 3.15; 95% confidence interval [CI]: 1.31-7.60; P = 0.006) and male sex (OR: 2.10; 95% CI: 1.23-3.58; P = 0.010) were significantly associated with COVID-19 vaccine hesitancy.

Vaccine hesitancy is a global issue. Patients with psychiatric disorders had the highest rate of vaccine hesitancy. Previous studies have shown that depression and anxiety are associated with a reduced adherence to the recommended medical advice. Why male sex is associated with vaccine hesitancy is not clear. Researchers should investigate the rates and the factors affecting the vaccine hesitancy in their corresponding communities.

To describe the development of the Patient Barcode Registration System (PBRS) over time and confirm the usability and feasibility of the system’s latest version during a large trauma drill.

The development of a PBRS started around 1993 aiming to provide an effective tool for patient registration, tracking, and tracing during major incidents. The PBRS uses wristbands with barcodes to follow and register patients in the care process. During a large trauma drill, 120 patients and 40 relatives were registered and traced in the system. Errors in registration, tracking, and tracing of persons were registered.

Of the 120 patients, no patient data were lost and patients could be traced in real time throughout the treatment process by the command team. Strategic decisions could be made based on the information provided by the system. Patient relatives were easily matched and government agencies received regular updates on the number and characteristics of the patients.

The PBRS is a usable, feasible, and sustainable patient tracking and tracing tool to be used during the hospital response to major incidents. Lessons learned during the last 20 years include the need for continuous updates to withstand the challenge of time. (Disaster Med Public Health Preparedness. 2017;11:244–250)

Our institution relocated to a new facility 3.5 miles from our original location in Chicago on June 9, 2012. We describe the tools we developed to prepare, execute, and manage our evacuation and relocation.

Tools developed for the planned evacuation included the following: level of acuity and team composition classification, patient departure checklist, evacuation handoff tool, and a patient tracking system within the electronic health record. Incident Command structure was utilized.

Monthly census tracking exercises were held beginning 12 months before the evacuation. Simulation drills began 6 months before the evacuation. The entire evacuation took less than 14 hours and there were no safety issues. A total of 127 patients were transported to the new facility: 45 patients were moved via the Neonatal/Pediatric Critical Care Transport Team, and the rest were moved with various team configurations.

Documents developed for a planned evacuation can be used for any planned or unplanned evacuation. We believe the tools we used to prepare, execute, and manage our evacuation and relocation would assist any health care facility to be better prepared to safely and efficiently evacuate patients in the event of a disaster, or to create surge capacity, and relocate them to another facility. (Disaster Med Public Health Preparedness. 2017;11:479–486)

On November 8, 2013, Typhoon Haiyan (Yolanda) made landfall in the Philippines. The literature characterizing the medical, surgical, and obstetrics burden following typhoons is lacking. This study aimed to improve disaster preparedness by analyzing medical diagnoses presenting to a city district hospital before, during, and after Typhoon Haiyan.

The assessment of disease burden and trends was based on logbooks from a local hospital and a nongovernmental organization field hospital for the medicine, surgical, and obstetrics wards before, during, and after the typhoon.

The hospital provided no services several days after typhoon impact, but there was an overall increase in patient admissions once the hospital reopened. An increase in gastroenteritis, pneumonia, tuberculosis, and motor vehicle collision-related injuries was seen during the impact phase. A dengue fever outbreak occurred during the post-impact phase. There was a noticeable shift in a greater percentage of emergent surgical cases performed versus elective cases during the impact and post-impact phases.

Overall, several public health measures can prevent the increase in illnesses seen after a disaster. To prepare for the nonfatal burden of disease after a typhoon, health care facilities should increase their resources to accommodate the surge in patient volume. (Disaster Med Public Health Preparedness. 2016;10:240–247)

To analyze acute hazardous substance release surveillance data for events involving secondary contamination of hospital emergency departments (EDs). Secondary contamination of EDs may occur when a patient exposed to a hazardous chemical is not decontaminated before arrival at the ED and when ED staff are not wearing appropriate personal protective equipment. This can result in adverse health outcomes among department personnel, other patients, and visitors. Even events without actual secondary contamination risk can be real in their consequences and require the decontamination of the ED or its occupants, evacuation, or temporary shutdown of the ED.

Events involving secondary contamination were identified by using the Hazardous Substances Emergency Events Surveillance system and the National Toxic Substance Incidents Program from 2007 to 2013.

Five incidents involving the threat of secondary contamination (0.02% of all events reported to the surveillance systems [n=33,001]) were detected and are described. Four incidents involved suspected secondary contamination in which the facility was evacuated or shut down.

These results suggest that although rare, incidents involving secondary contamination continue to present a hazard for emergency departments. Suggested best practices to avoid secondary contamination have been described. Hospitals should be made aware of the risks associated with secondary contamination and the need to proactively train and equip staff to perform decontamination. (Disaster Med Public Health Preparedness. 2016;10:199–202)

This study examined the association between psychological distress and the risk of withdrawing from hypertension treatment (HTTx) 1 year after the earthquake disaster in the coastal area affected by the Great East Japan Earthquake (GEJE).

Using cross-sectional data from 2012, we studied people over 20 years of age living in Shichigahama Town, Miyagi, on the northeastern coast of Japan, which had been severely inundated by the tsunami that followed the GEJE in 2011. A total of 1014 subjects were categorized as in need of HTTx. Withdrawing from HTTx was assessed by using a self-reported questionnaire.

Subjects with a higher degree of psychological distress (Kessler-6 [K6] score ≥ 13) exhibited a significantly higher risk of withdrawing from HTTx, compared with subjects with a lower degree of psychological distress (K6 score ≤ 12; odds ratio=4.0; 95% confidence interval: 1.3-10.6, P<0.01).

This study indicated that psychological distress is a risk factor for withdrawing from HTTx in post-disaster settings. Our data suggested that the increased risk of withdrawing from HTTx associated with post-disaster psychological distress may underlie the increased prevalence of vascular diseases after the earthquake disaster in coastal areas affected by the tsunami. (Disaster Med Public Health Preparedness. 2017;11:179–182)

For close to a decade, the Gulf Coast of the United States has been in almost constant disaster recovery mode, and a number of lessons have been learned concerning disaster recovery and behavioral health. The purpose of this report was to describe the natural development of a Gulf Coast Resilience Coalition (GCRC).

The GCRC methods began with state-specific recovery goals following Hurricane Katrina in 2005 and transitioned to a shared multistate and multidiscipline coalition. The coalition’s effectiveness is demonstrated through continuation, procurement of funding to provide response services, and increased membership to ensure sustainability.

The coalition has enhanced response, recovery, and resilience by providing strategic plans for dissemination of knowledge; post-disaster surveillance and services; effective relationships and communication with local, state, and regional partners; disaster response informed by past experience; a network of professionals and community residents; and the ability to improve access to and efficiency of future behavioral health coordination through an organized response.

The GCRC can not only improve readiness and response, but work toward a shared vision of improved overall mental and behavioral health and thus resilience, with beneficial implications for the Gulf South and other communities as well. (Disaster Med Public Health Preparedness. 2015;9:657–665)

To identify the prevalence of posttraumatic stress disorder (PTSD) and its determinants among adolescents more than 4 years after the 2008 Wenchuan earthquake.

Adolescents (1,125 total) from 2 junior high schools in areas affected by the catastrophic earthquake were followed up for 3 years. The self-rating PTSD scale based on the Manual of Mental Disorders, 4th Edition (DSM-IV) and the Chinese Classification and Diagnostic Criteria of Mental Disorders, 2nd Edition, Revised (CCMD-2-R) was collected at 53 months, and determinant data were collected repeatedly. Logistic regression was used for a determinants analysis.

The prevalence of overall PTSD was 23.4% among the sample. The risk factors for PTSD were older age (OR=1.52, 95% CI: 1.20~1.92), and death or injury of a family member in the earthquake (OR=1.61, 95% CI: 1.09~2.37). Adolescents who had moderate-to-severe common mental health problems were more likely to have PTSD symptoms, with ORs from 3.98 to 17.67 (All P<0.05). Self-esteem remained a protective factor for PTSD regardless of age, whereas positive coping was a protective factor for PTSD when adolescents were older.

PTSD symptoms among adolescent survivors of a catastrophic earthquake seemed to persist over time. Long-term interventions are needed to alleviate PTSD symptoms among adolescent survivors. (Disaster Med Public Health Preparedness. 2019;13:414-418)

When 2017 Hurricane Harvey struck the coastline of Texas on August 25, 2017, it resulted in 88 fatalities and more than US $125 billion in damage to infrastructure. The floods associated with the storm created a toxic mix of chemicals, sewage and other biohazards, and over 6 million cubic meters of garbage in Houston alone. The level of biohazard exposure and injuries from trauma among persons residing in affected areas was widespread and likely contributed to increases in emergency department (ED) visits in Houston and cities receiving hurricane evacuees. We investigated medical surge resulting from these evacuations in Dallas–Fort Worth (DFW) metroplex EDs.

We used data sourced from the North Texas Syndromic Surveillance Region 2/3 in ESSENCE to investigate ED visit surge following the storm in DFW hospitals because this area received evacuees from the 60 counties with disaster declarations due to the storm. We used the interrupted time series (ITS) analysis to estimate the magnitude and duration of the ED surge. ITS was applied to all ED visits in DFW and visits made by patients residing in any of the 60 counties with disaster declarations due to the storm. The DFW metropolitan statistical area included 55 hospitals. Time series analyses examined data from March 1, 2017–January 6, 2018 with focus on the storm impact period, August 14–September 15, 2017. Data from before, during, and after the storm were visualized spatially and temporally to characterize magnitude, duration, and spatial variation of medical surge attributable to Hurricane Harvey.

During the study period overall, ED visits in the DFW area rose immediately by about 11% (95% CI: 9%, 13%), amounting to ~16 500 excess total visits before returning to the baseline on September 21, 2017. Visits by patients identified as residing in disaster declaration counties to DFW hospitals rose immediately by 127% (95% CI: 125%, 129%), amounting to 654 excess visits by September 29, 2017, when visits returned to the baseline. A spatial analysis revealed that evacuated patients were strongly clustered (Moran’s I = 0.35, P < 0.0001) among 5 of the counties with disaster declarations in the 11-day window during the storm surge.

The observed increase in ED visits in DFW due to Hurricane Harvey and ensuing evacuation was significant. Anticipating medical surge following large-scale hurricanes is critical for community preparedness planning. Coordinated planning across stakeholders is necessary to safeguard the population and for a skillful response to medical surge needs. Plans that address hurricane response, in particular, should have contingencies for support beyond the expected disaster areas.