Background: A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning.

Methods: We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data.

Results: Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care.

Conclusions: Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major incident.

(Disaster Med Public Health Preparedness. 2010;4:226-231)

Objective: The paucity of evidence and wide variation among communities creates challenges for developing congressionally mandated national performance standards for public health preparedness. Using countermeasure dispensing as an example, we present an approach for developing standards that balances national uniformity and local flexibility, consistent with the quality of evidence available.

Methods: We used multiple methods, including a survey of community practices, mathematical modeling, and expert panel discussion.

Results: The article presents recommended dispensing standards, along with a general framework that can be used to analyze tradeoffs involved in developing other preparedness standards.

Conclusions: Standards can be developed using existing evidence, but would be helped immensely by a stronger evidence base.

(Disaster Med Public Health Preparedness. 2010;4:285-290)

Every year, there are larger and more severe disasters and health organizations are struggling to respond with services to keep public health systems running. Making decisions with limited health information can negatively affect response activities and impact morbidity and mortality. An overarching challenge is getting the right health information to the right health service personnel at the right time. As responding agencies engage in social media (eg, Twitter, Facebook) to communicate with the public, new opportunities emerge to leverage this non-traditional information for improved situational awareness. Transforming these big data is dependent on computers to process and filter content for health information categories relevant to health responders. To enable a more health-focused approach to social media analysis during disasters, 2 major research challenges should be addressed: (1) advancing methodologies to extract relevant information for health services and creating dynamic knowledge bases that address both the global and US disaster contexts, and (2) expanding social media research for disaster informatics to focus on health response activities. There is a lack of attention on health-focused social media research beyond epidemiologic surveillance. Future research will require approaches that address challenges of domain-aware, including multilingual language understanding in artificial intelligence for disaster health information extraction. New research will need to focus on the primary goal of health providers, whose priority is to get the right health information to the right medical and public health service personnel at the right time.

Almost 2 million Americans rely on nursing homes for care, and many require daily or near daily contact with the health care system to remain alive and functional. In October 2007, Southern California experienced a series of wildfires that burned over 500 000 acres and caused 14 nursing homes to evacuate more than 1200 residents. In response to this event, nursing home administrators and officials from various health care and emergency management agencies in San Diego County collaborated to form a model for nursing home emergency preparedness. This report describes the model, known as the area coordinator system, and discusses its strengths and limitations, and whether it ought to be replicated in other areas of the country.

(Disaster Med Public Health Preparedness. 2012;6:424-427)

Disasters can cause long-lasting damage to survivors and rescue workers. Some rescue workers suffer negative physical and psychological consequences, while others do not. Thus, it is of value to fully understand the characteristics of rescuers who have not been affected by rescue activities. Resilience refers to the ability or capacity to cope with adversity. The aim of this review is to explore and identify the characteristics of resilience among rescue workers. A systematic literature search was conducted of seven electronic databases from inception to May 2019, using keywords and medical subject heading terms related to the resilience of rescuers. Hand searches and searches of leading authors were also performed. A total of 31 articles were eligible for review. Six domains were identified to characterize the resilience of rescuers namely, demographic and physical characteristics, personality traits, coping strategies, perceived resources, being equipped with special skills for disaster rescue, and having less adverse consequences from exposure to disaster. Researchers and disaster managers can take note of these characteristics to comprehensively understand the ‘positive concept’ of resilience. This enhanced understanding of ‘positive resilience’ can in turn be used to develop a framework to assess and establish interventions, and consequently to improve the psychological wellbeing of rescuers after disaster rescue efforts.

An important shift in terminology has occurred in emergency preparedness, and the concept of community resilience has become ubiquitous. Although enhancing community resilience is broader than preparedness, and emphasizes a distinct set of activities and participants, the terms are often used interchangeably. The implications of this shift have not been fully explored. This commentary describes the potential promise and pitfalls of the concept of community resilience and recommends strategies to overcome its limitations. We believe that resilience has the power to dramatically change this field in immense, positive ways, but some important challenges such as confusion about definitions and lack of accountability must first be overcome. (Disaster Med Public Health Preparedness. 2013;7:603-606)

The national response to the coronavirus disease 2019 (COVID-19) pandemic has highlighted critical weaknesses in domestic health care and public health emergency preparedness, despite nearly 2 decades of federal funding for multiple programs designed to encourage cross-cutting collaboration in emergency response. Health-care coalitions (HCCs), which are funded through the Hospital Preparedness Program, were first piloted in 2007 and have been continuously funded nationwide since 2012 to support broad collaborations across public health, emergency management, emergency medical services, and the emergency response arms of the health-care system within a geographical area. This commentary provides a SWOT (strengths, weaknesses, opportunities, and threats) analysis to summarize the strengths, weaknesses, opportunities, and threats related to the current HCC model against the backdrop of COVID-19. We close with concrete recommendations for better leveraging the HCC model for improved health-care system readiness. These include better evaluating the role of HCCs and their members (including the responsibility of the HCC to better communicate and align with other sectors), reconsidering the existing framework for HCC administration, increasing incentives for meaningful community participation in HCC preparedness, and supporting next-generation development of health-care preparedness systems for future pandemics.

The unanticipated global outbreak of Zika virus infection is the most current but certainly not the last emerging infectious disease challenge to confront the US public heath system. Despite a number of such threats in recent years, significant gaps remain in core areas of public health system readiness. Stable, sustained investments are required to establish a solid foundation for achieving necessary national public health emergency preparedness and response capacity. (Disaster Med Public Health Preparedness. 2016;10:298–299)

Public health agencies simply do not have enough trained staff or volunteers to effectively respond to a large-scale disaster. Training volunteers “off the street” will be crucial—but time consuming—in a public health emergency. A centralized volunteer staging and training area can help to efficiently register, credential, and conduct just-in-time training of volunteers, while reducing stress, confusion, traffic congestion, and security issues at various mass dispensing clinics. (Disaster Med Public Health Preparedness. 2008;2:127–129)

In April 2015, Nepal experienced an earthquake of a magnitude of 7.6 on the Richter scale that resulted in deaths, morbidities, and infrastructure damage. In the post-earthquake period, 4 different workshops and a national “Lessons Learnt” conference were organized to assess the adequacy of the preparedness and response of the health sector. This article summarizes the main conclusions of these discussions relating to leadership, timely search and rescue, referral operations, medical relief to response activities, awareness campaigns, and support from the national and international levels, and epidemiological surveillance. The earthquake response was channeled through rapid response teams that spanned from the community level to the central level via a cluster coordination approach. Overall, the health sector’s response was concluded to be largely satisfactory because it focused not only on emergency medical care, but also on the resumption of basic health services and preventive health care (eg, hygiene, risk communication) equally. Post-disaster disease outbreak did not occur because effective surveillance and outbreak monitoring was one of the priority actions. However, services related to birthing centers, neonatal services, and vaccinations were impeded in some rural areas. Some weaknesses in planning, coordination, and management were also noted. The lessons learned can provide the impetus to strengthen future preparedness and response mechanisms. (Disaster Med Public Health Preparedness. 2018;12:543–547)

The Second Evidence Aid Conference took place in Brussels, Belgium, in October 2012, jointly organized by Evidence Aid and the Belgian Red Cross–Flanders. It provided an opportunity to build on the discussions from the 2011 First Evidence Aid Conference in Oxford, England, and prioritize the future work of Evidence Aid. Within the plenary presentations, discussions, and small work groups, the more than 80 international participants addressed issues regarding the need, use, and prioritization of evidence. Three parallel workshops focused on the prioritization of research, systematic reviews, and data to be collected during disasters, leading to a suggested prioritization framework and a commitment to identify key areas for evidence in disasters. Working with a wide variety of people and organizations from the disaster and humanitarian sectors, Evidence Aid will take this framework and develop a list of top priority questions in need of research and systematic reviews. Although Evidence Aid will not be able to address all of the research questions that will be identified in this process, it will collect them for sharing with relevant agencies. (Disaster Med Public Health Preparedness. 2013;7:593-596)