The aim of this study was to provide insights learned from disaster research response (DR2) efforts following Hurricane Harvey in 2017 to launch DR2 activities following the Intercontinental Terminals Company (ITC) fire in Deer Park, Texas, in 2019.

A multidisciplinary group of academic, community, and government partners launched a myriad of DR2 activities.

The DR2 response to Hurricane Harvey focused on enhancing environmental health literacy around clean-up efforts, measuring environmental contaminants in soil and water in impacted neighborhoods, and launching studies to evaluate the health impact of the disaster. The lessons learned after Harvey enabled rapid DR2 activities following the ITC fire, including air monitoring and administering surveys and in-depth interviews with affected residents.

Embedding DR2 activities at academic institutions can enable rapid deployment of lessons learned from one disaster to enhance the response to subsequent disasters, even when those disasters are different. Our experience demonstrates the importance of academic institutions working with governmental and community partners to support timely disaster response efforts. Efforts enabled by such experience include providing health and safety training and consistent and reliable messaging, collecting time-sensitive and critical data in the wake of the event, and launching research to understand health impacts and improve resiliency.

To assess ability of National Early Warning Score 2 (NEWS2), systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and CRB-65 calculated at the time of intensive care unit (ICU) admission for predicting ICU mortality in patients of laboratory confirmed coronavirus disease 2019 (COVID-19) infection.

This prospective data analysis was based on chart reviews for laboratory confirmed COVID-19 patients admitted to ICUs over a 1-mo period. The NEWS2, CRB-65, qSOFA, and SIRS were calculated from the first recorded vital signs upon admission to ICU and assessed for predicting mortality.

Total of 140 patients aged between 18 and 95 y were included in the analysis of whom majority were >60 y (47.8%), with evidence of pre-existing comorbidities (67.1%). The most common symptom at presentation was dyspnea (86.4%). Based upon the receiver operating characteristics area under the curve (AUC), the best discriminatory power to predict ICU mortality was for the CRB-65 (AUC: 0.720 [95% confidence interval [CI]: 0.630-0.811]) followed closely by NEWS2 (AUC: 0.712 [95% CI: 0.622-0.803]). Additionally, a multivariate Cox regression model showed Glasgow Coma Scale score at time of admission (P < 0.001; adjusted hazard ratio = 0.808 [95% CI: 0.715-0.911]) to be the only significant predictor of ICU mortality.

CRB-65 and NEWS2 scores assessed at the time of ICU admission offer only a fair discriminatory value for predicting mortality. Further evaluation after adding laboratory markers such as C-reactive protein and D-dimer may yield a more useful prediction model. Much of the earlier data is from developed countries and uses scoring at time of hospital admission. This study was from a developing country, with the scores assessed at time of ICU admission, rather than the emergency department as with existing data from developed countries, for patients with moderate/severe COVID-19 disease. Because the scores showed some utility for predicting ICU mortality even when measured at time of ICU admission, their use in allocation of limited ICU resources in a developing country merits further research.

The aim of this study was to investigate the basic preparedness of rural community pharmacies to continue operations during and immediately following a disaster.

In 2014, we conducted a telephone survey (N = 990) of community pharmacies in 3 rural areas: North Dakota/South Dakota, West Virginia, Southern Oregon/Northern California regarding whether they had a formal disaster/continuity plan, offsite data backup, emergency power generation, and/or had a certified pharmacy immunizer on staff. Logistic regression and chi square were performed using Stata 11.1.

Community pharmacies in rural areas (≤50.0 persons/mile2) were less likely to have emergency power (odds ratio [OR] = 0.59; 95% confidence interval [CI]: 0.32-1.07) or certified pharmacy immunizer on staff (OR = 0.47; 95% CI: 0.34-0.64). Pharmacies in lower income areas were less likely to have emergency power and offsite data backup or a formal disaster plan (OR = 0.70; 95% CI: 0.49-0.99) compared with pharmacies in higher income areas. Community pharmacies in areas of higher percent elderly population were less likely to have emergency power (OR = 0.54; 95% CI: 0.39-0.73), or certified pharmacy immunizer on staff (OR = 0.65; 95% CI: 0.47-0.91) compared with chain pharmacies in areas with lower percent elderly population.

Being in a rural, low-income, or high-elderly area was associated with lower likelihood of basic preparedness of community pharmacies.

To investigate knowledge and practice of Brazilian public primary and secondary health care dentists during the coronavirus disease (COVID-19) pandemic.

An online questionnaire with sociodemographic and COVID-19 knowledge questions was used.

A total of 4048 dentists working in the Brazilian public primary and secondary health care system were investigated; 4024 (99.41%) believe that COVID-19 can be transmitted through dental procedures. A fair level of COVID-19 symptoms knowledge by these dentists was observed (3.76±1.27 of 6.00), as well as the skepticism in personal protective equipment (3382; 83.55%) and biosafety procedures (3278; 80.98%) used as an efficient form of COVID-19 transmission prevention. Country region, performance of social distancing, dental specialty, the use of personal protective equipment, and biosafety preventive measures influenced the likelihood of dentists to perform dental treatment, either elective or urgent, during the COVID-19 pandemic.

The need of extra preventive barriers for dental treatment may bring an extra financial stress in the Brazilian public primary and secondary health care system, as well as in the patient-dentist relationship, which may have to be reframed. Internationally accepted public guideline policies regarding dental treatment safety, as well as the technological development of preventive tools, are needed to deal with the challenges brought by COVID-19.

Parents and children are vulnerable populations following hurricanes, and evacuation is an important safety strategy. Yet, little is known about “before the storm” stressors, particularly the surrounding evacuation, affecting families. Thus, following Hurricane Irma, we evaluated both stressful and positive aspects of the evacuation process for families, and we compared perceived safety and stress before, during, and after the hurricane across evacuating and non-evacuating families.

South Florida parents of children under age 18 years (N=554; 97% mothers) completed an online survey in the months following Hurricane Irma, assessing perceptions of stress, safety, and evacuation experiences. Quantitative data and open-ended responses were gathered.

Most families (82%) residing in mandatory evacuation zones evacuated, although many not in mandatory zones (46%) also evacuated. Parents who evacuated felt significantly safer during the storm, but more stressed before and during the storm, than non-evacuees. Evacuation-related travel and multiple family issues were rated as most stressful, although some positive aspects of evacuation were offered.

Findings have implications for emergency planners (eg, pre-/post-storm traffic flow needs, emotional needs of parents arriving at shelters) and for families (eg, importance of developing family disaster plans, controlling media exposure) to reduce evacuation stress for future storms. (Disaster Med Public Health Preparedness. 2019;13:63-73)

This study evaluates the personal and professional experiences of physician mothers during the coronavirus disease 2019 (COVID-19) pandemic and the impact of the pandemic on the lives of physician mothers.

Using social media to reach a broad range of physicians, a convenience sample of physician mothers completed an on-line survey posted between April 27 and May 11. Members were encouraged to repost on social media and share with personal contacts resulting in a passive snowball sampling effect.

A total of 2709 physician mothers from 48 states, Puerto Rico, and 19 countries representing more than 25 medical specialties completed the survey. Most were between 30 and 39 y of age, 67% self-identified as white, 17% as Asian, 4% as African American. Most had been working for 11-16 y. A total of 91% had a spouse/partner of the opposite sex. Over half were practicing in an area they identified as high COVID-19 density, while 50% had personally cared for a person with COVID-19. Physician mothers were most concerned about exposing their children to COVID-19 and about the morale and safety of their staff.

This is one of the first studies to explore the personal and professional challenges facing physician mothers during a pandemic. Physician mothers were most concerned about exposing their families to COVID-19. Mothers continued to work and at times increased their work, despite having domestic, childcare, and schooling responsibilities.

This study describes the epidemiologic features of an outbreak of the coronavirus disease (COVID-19) in Tianjin caused by a novel coronavirus and provides the scientific basis for prevention and control measures.

Data from COVID-19 cases were collected from daily notifications given to the National Health Commission of the People’s Republic of China and Tianjin Health Committee. All of the data were analyzed with SPSS, version 24.0 software (IBM Corp, Armonk, NY).

As of February 24, 2020, there have been 135 confirmed cases, 3 deaths, and 87 recoveries in Tianjin, China. The incidence of COVID-19 was 8.65/1 000 000 with a 2.22% case fatality rate. Regarding geographic distribution, the incidence was 8.82 per 1 000 000 in urban areas and 8.00 per 1 000 000 in suburbs. During the early stage of the epidemic, most cases came from urban areas and in patients with a history of sojourning in Hubei Province. The majority of patients were 31–70 years old (75.97%). A familial clustering was the most important characteristic of COVID-19 (accounting for 74.81%).

Current information suggests that people are generally susceptible to COVID-19, which has shown a familial clustering in Tianjin.

The authors aim to demonstrate that the current drive-through testing model at a health district was improved in certain parameters compared with a previous testing protocol, and to provide the methodology of the current model for other coronavirus disease (COVID-19) testing sites to potentially emulate.

Initially, a small drive-through site was constructed at a converted tuberculosis clinic, but due to an increase in testing needs, an expanded point of screening and testing (POST) system was developed in an event center parking lot to administer tests to a higher volume of patients.

An average of 51.1 patients was tested each day (2.0 tests per personnel in personal protective equipment [PPE] per hour) at the initial tuberculosis clinic drive-through site, which increased to 217.8 patients tested each day (5.9 tests per personnel in PPE per hour) with the new drive-through POST system (P < 0.001). Mean testing time was 3.4 minutes and the total time on-site averaged 14.4 minutes.

This POST drive-through system serves as an efficient, safe, and adaptable model for high volume COVID-19 nasopharyngeal swabbing that the authors recommend other COVID-19 testing sites nationwide consider adopting for their own use.

This study aimed to design and develop a self-report Disaster Literacy Scale (DLS) tool that could evaluate the knowledge and skills of an individual specific to Turkish society.

Item development, expert opinions, language control, pilot study and field testing processes were monitored in the measurement tool based on a conceptual model and recognition.

23 items were taken out since their common variance values (>0,508, >0.500, >0.500, >0.400, respectively) and factor load relationship (>0.46, >0.50, >0.50, >0.50 and >0.55, respectively) in the mitigation, preparedness, response and recovery phases of the Exploratory Factor Analysis were insufficient. The Cronbach Alpha value of the remaining 61 items in the Disaster Literary Scale is 0.954 and between 0.83-0.88 in lower dimensions. DLS scoring was standardized between 0-50 points.

The objectives, scopes, limitations and steps of the design and development process of the Disaster Literacy Scale were given in detail and made understandable for other societies. The Disaster Literacy Scale was developed as a self-report scale that could evaluate the knowledge and skills of Turkish society in disasters. The Disaster Literacy Scale is, therefore, expected to be accepted in more countries to improve the understanding of disaster literacy in different societies.

Hurricane evacuation is one of the strategies employed by emergency management and other agencies to reduce morbidity and mortality associated with hurricanes. However, factors associated with residents’ evacuation decision-making have been inconsistent. In this study, we conducted a statistical meta-analysis to identify factors associated with hurricane evacuation as well as moderators of the evacuation decision.

A systematic literature search identified 36 studies published between 1999 and 2018. Pooled estimates were calculated using random-effects models, and heterogeneity across studies was checked using both Q and I2 statistics. Meta-regression methods were used to identify moderators. Publication bias was assessed using both visual (funnel plots) and statistical methods.

Mobile home residence, perception of risk, female sex, and Hispanic ethnicity were statistically associated with hurricane evacuation, while geographic region modified the relationship between Hispanic race and evacuation.

Agencies responsible for preparedness may utilize these findings to identify specific population sub-groups for hurricane evacuation communication and other interventions. Future studies should consider statistical interactions and explore opportunities for research translation to emergency officials.

To assess individual variation in anxiety, stress disorder, depression, insomnia, burnout, and resilience in health care workers (HCWs), 12 and 18 months after the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

Prospective longitudinal study.

A total of 207 HCWs (74% female, 46% physicians, 44% nurses) answered; 50% scored over the cut-off for anxiety (GAD-7), 66% for PCL-C, 41% for depression (PHQ-9), 25% for ISI, and 15% started sleep inducers; 52% showed emotional exhaustion (EE), 68% detachment (DE), 39% professional efficacy (EF) at MBI; 27% completed the follow-up questionnaire 6 months later, showing a significant reduction in nearly all scores (GAD-7 median 11[5-15] vs 7[4-12] (P < 0.001); PCL-C 43[30-58] vs 37[24-50] (P < 0.05); PHQ-9 10[4-16] vs 6[3-12] (P < 0.001); ISI 10[4-15] vs 7[5-12](NS); MBI EE 25[16-35] vs 23 [15-31] (NS), DE 13[8-17] vs 12[8-17], EF 29[25-34] vs 30[25-34]. Living in a flat (OR 2.27 [1.10-4.81], high-intensity-of-care working (2.83 [1.15-7.16] increased risk of anxiety (GAD-7); age between 31-40 y (OR 2.8 [1.11-7.68], being a nurse (OR 3.56 [1.59-8.36] and high-intensity-of-care working (OR 8.43 [2.92-26.8] increased risk of pathological stress (PCL-C).

Nearly half of HCWs showed psychological distress, especially nurses, women, and the youngest. A mandatory job change, increasing intensity of care, working in a COVID-19 department, and being infected were negative factors; having a partner and living in a detached house were protective. Six months later, all the psychological domains showed individual improvement.

In 2010, South Africa (SA) hosted the Fédération Internationale de Football Association (FIFA) World Cup (soccer). Emergency Medical Services (EMS) used the SA mass gathering medicine (MGM) resource model to predict resource allocation. This study analyzed data from the World Cup and compared them with the resource allocation predicted by the SA mass gathering model.

Prospectively, data were collected from patient contacts at 9 venues across the Western Cape province of South Africa. Required resources were based on the number of patients seeking basic life support (BLS), intermediate life support (ILS), and advanced life support (ALS). Overall patient presentation rates (PPRs) and transport to hospital rates (TTHRs) were also calculated.

BLS services were required for 78.4% (n = 1279) of patients and were consistently overestimated using the SA mass gathering model. ILS services were required for 14.0% (n = 228), and ALS services were required for 3.1% (n = 51) of patients. Both ILS and ALS services, and TTHR were underestimated at smaller venues.

The MGM predictive model overestimated BLS requirements and inconsistently predicted ILS and ALS requirements. MGM resource models, which are heavily based on predicted attendance levels, have inherent limitations, which may be improved by using research-based outcomes.

This study aims to identify error-prone operational steps and key sites of self-contamination during donning and doffing of personal protective equipment (PPE).

A total of 56 health care workers, including 37 nurses and 19 physicians, were recruited to don and doff the PPE recommended by the Chinese Center for Disease Control and Prevention. Operational errors and sites of self-contamination were recorded using UV-fluorescent labeling and video surveillance.

Three main errors during donning were identified: choosing a loose-fitting coverall that was difficult to handle; ignoring to inspect the seal of N95 respirator or gloves; and forgetting to pull up the zipper completely. Four main errors during doffing were identified: removing the N95 respirator in a wrong way; touching the scrubs with contaminated hands and elbows; touching contaminated external surfaces of the goggles; and performing insufficient hand hygiene. Key sites that were easily contaminated during the doffing of PPE included left hand and wrist, left lower leg, chest, and left abdomen.

Identifying the steps prone to errors and key sites of self-contamination in the process of PPE donning and doffing can facilitate the training of PPE use and provide detailed evidence for optimizing standardized protocols to reduce contamination.