In an effort to support the mental health of Albertans during the coronavirus disease 2019 (COVID-19) pandemic, Alberta Health Services launched a supportive text message (Text4Mood) program on March 23, 2020. The program was simultaneously approved for funding by the 6 regional health foundations and launched within 1 week of conception. Residents of Alberta can subscribe to the program by texting “COVID19HOPE” to a sort code number. Each subscriber receives free daily supportive text messages, for 3 months, crafted by a team of clinical psychologists, psychiatrists, mental health therapist, and mental health service users. Within 1 week of the launch of Text4Hope, 32 805 subscribers had signed up to the program, and there have been expressions of interests from other jurisdictions to implement a similar program to support the mental health of those in quarantine, isolation, or lockdown.

Background: Hospital emergency department (ED) clinicians will play a crucial role in responding to any terrorist incident involving radioactive materials. To date, however, there has been a paucity of research focusing specifically on ED clinicians’ perspectives regarding this threat.

Methods: At the request of the Centers for Disease Control and Prevention, researchers at the University of Alabama at Birmingham conducted a series of 10 focus groups (total participants, 77) with ED physicians and nurses at hospitals in 3 US regions. Participants considered a hypothetical “dirty bomb” scenario and discussed their perceptions, concerns, information needs, preferred information sources, and views of current guidance and informational materials.

Results: Study participants consistently expressed the view that neither EDs nor hospital facilities are sufficiently prepared for a terrorist event involving radioactive materials. Key clinician concerns included the possibility of the hospital being overwhelmed, safety of loved ones, potential staffing problems, readiness problems, and contamination and self-protection. Participants also expressed a need for additional information, strongly disagreed with aspects of current response guidance, and in some cases indicated they would not carry out current protocols.

Conclusions: This study is the first to examine the views, perceptions, and information needs of hospital ED clinicians regarding radiological terrorism. As such, the findings may be useful in informing current and future efforts to improve hospital preparedness. (Disaster Med Public Health Preparedness. 2008;2:174–184)

Objectives: We conducted a county-wide survey to assess the ability and willingness of health care workers to report to work during a pandemic influenza and a severe earthquake and to identify barriers and strategies that would help them report to work.

Methods: A stratified random sample of 9211 health care workers was selected from the Washington state licensure database and from health care agencies. We assessed correlates between self-reported ability and willingness to report to work and demographic and employer-related variables under two scenarios, influenza pandemic and a severe earthquake.

Results: For the influenza pandemic scenario, 95% of respondents reported that they would be able and 89% reported that they would be willing to report to their usual place of work. Seventy-four percent of respondents reported that they would be able and 88% would be willing to report to their usual place of work following a severe earthquake. The most frequently cited strategies that would help respondents report to work during an influenza pandemic were the availability of anti-viral influenza treatment and the ability to work from home. For persons with children at home, the strategy to increase ability to report to work during an earthquake was the availability of child care.

Conclusions: The majority of the King County health care workforce is willing and able to respond to an influenza pandemic or a severe earthquake.

(Disaster Med Public Health Preparedness. 2011;5:300–308)

Because of the importance of including ethical considerations in planning efforts for pandemic influenza, in February 2005 the Centers for Disease Control and Prevention requested that the Ethics Subcommittee of the Advisory Committee to the Director develop guidance that would serve as a foundation for decision making in preparing for and responding to pandemic influenza. Specifically, the ethics subcommittee was asked to make recommendations regarding ethical considerations relevant to decision making about vaccine and antiviral drug distribution prioritization and development of interventions that would limit individual freedom and create social distancing. The ethics subcommittee identified a number of general ethical considerations including identification of clear goals for pandemic planning, responsibility to maximize preparedness, transparency and public engagement, sound science, commitment to the global community, balancing individual liberty and community interests, diversity in ethical decision making, and commitment to justice. These general ethical considerations are applied to the issues of vaccine and antiviral drug distribution and use of community mitigation interventions. (Disaster Med Public Health Preparedness. 2009;3(Suppl 2):S185–S192)

Objective: Hurricane Katrina highlighted both the crucial role of first responders in times of disaster and the resultant stress on them and their families. The primary objective of this study was to describe the mental health status and symptoms of first responders in the New Orleans area. We further hypothesized that given the extent of the disaster and slowness of recovery, symptoms of posttraumatic stress and depression would not decrease after the first-year anniversary of Hurricane Katrina.

Methods: A total of 1382 first responders, including respondents from police, fire, emergency medical services, and city workers, participated in this longitudinal study. The first screening was conducted between 6 and 9 months after Hurricane Katrina and the second round of data collection was conducted 13 to 18 months after the hurricane. A subsample of the respondents (n = 87) were matched at both time points, which allowed for paired sample comparisons. We measured all of the respondents' levels of traumatic experiences, alcohol use, partner conflict, requests for services, posttraumatic stress, and depression.

Results: More than one-quarter of the first responders reported the following traumatic experiences: witnessed injury or death (70%); damage to home (93%); injury to a friend (25%); and previous loss or trauma (30%). Data also revealed that at least 10% of the respondents had significant levels of posttraumatic stress symptoms; 25% of the participants reported significant levels of depression; and more than 40% reported increased alcohol use and conflict with partner (41%). A statistically significant decrease in the symptoms of posttraumatic stress or depression was not found within 18 months of Hurricane Katrina.

Conclusions: Results suggest that the severity of the traumas experienced from both the impact of Hurricane Katrina and the subsequent recovery has important mental health implications for first responders. Reports of symptoms of anxiety or depression should be attended to so as to prevent increasing symptoms that could negatively affect the first responder and his or her family. These findings highlight the importance of not only providing mental health services for first responders but also having adequate plans in place before natural or technological disasters strike.

(Disaster Med Public Health Preparedness. 2011;5:S214-S219)

Climate change is increasingly forcing population displacement, better described by the phrase environmentally induced forced migration. Rising global temperatures, rising sea levels, increasing frequency and severity of natural disasters, and progressive depletion of life-sustaining resources are among the drivers that stimulate population mobility. Projections forecast that current trends will rapidly accelerate. This will lead to an estimated 200 million climate migrants by the year 2050 and create dangerous tipping points for public health and security.

Among the public health consequences of climate change, environmentally induced forced migration is one of the harshest and most harmful outcomes, always involving a multiplicity of profound resource and social losses and frequently exposing migrants to trauma and violence. Therefore, one particular aspect of forced migration, the effects of population displacement on mental health and psychosocial functioning, deserves dedicated focus. Multiple case examples are provided to elucidate this theme. (Disaster Med Public Health Preparedness. 2019;13:116–122)

This study analyzes the incidence of posttraumatic stress disorder (PTSD) among flood victims, between different flood intensities, and between different time points after a flood. A search of several electronic literature databases was conducted to collect data on the incidence of PTSD after a flood. Loney criteria for research quality were used to evaluate the quality of selected search results. The combined incidence of PTSD was estimated using the Freeman-Tukey double arcsine transformation method. Subgroup analyses were conducted on different trauma intensities and different time points after a flood. Sensitivity analysis was performed to evaluate the impact of research quality. Fourteen articles were included in this meta-analysis, including a total of 40 600 flood victims; 3862 victims were diagnosed with PTSD. The combined incidence of PTSD was 15.74%. The subgroup analyses showed that the incidence of PTSD in victims who experienced severe and moderate flood intensity was higher than that in victims who experienced mild flood intensity. The incidence of PTSD was lower at 6 or more months after a flood (11.45%) than within 6 months (16.01%) of a flood. In conclusion, the incidence of PTSD among floods of different trauma intensities was statistically significant. (Disaster Med Public Health Preparedness. 2015;9:329-333)

Social media research during natural disasters has been presented as a tool to guide response and relief efforts in the disciplines of geography and computer sciences. This systematic review highlights the public health implications of social media use in the response phase of the emergency, assessing (1) how social media can improve the dissemination of emergency warning and response information during and after a natural disaster, and (2) how social media can help identify physical, medical, functional, and emotional needs after a natural disaster. We surveyed the literature using 3 databases and included 44 research articles. We found that analyses of social media data were performed using a wide range of spatiotemporal scales. Social media platforms were identified as broadcasting tools presenting an opportunity for public health agencies to share emergency warnings. Social media was used as a tool to identify areas in need of relief operations or medical assistance by using self-reported location, with map development as a common method to visualize data. In retrospective analyses, social media analysis showed promise as an opportunity to reduce the time of response and to identify the individuals’ location. Further research for misinformation and rumor control using social media is needed.

Many countries have enacted a quick response to the unexpected coronavirus disease 2019 (COVID-19) pandemic by using existing technologies. For example, robotics, artificial intelligence, and digital technology have been deployed in hospitals and public areas for maintaining social distancing, reducing person-to-person contact, enabling rapid diagnosis, tracking virus spread, and providing sanitation. In this study, 163 news articles and scientific reports on COVID-19-related technology adoption were screened, shortlisted, categorized by application scenario, and reviewed for functionality. Technologies related to robots, artificial intelligence, and digital technology were selected from the pool of candidates, yielding a total of 50 applications for review. Each case was analyzed for its engineering characteristics and potential impact on the COVID-19 pandemic. Finally, challenges and future directions regarding the response to this pandemic and future pandemics were summarized and discussed.

Objective: The potential for deadly human stampedes to occur at any mass gathering event highlights this unique form of crowd disaster as deserving of special attention from both scientific and planning perspectives. Improved understanding of human stampedes is indispensable in the mitigation of this type of mass casualty. With relatively few peer-reviewed reports on deadly human stampedes, information from news reports and the Internet is essential to increased collective understanding. Without incorporating nontraditional sources, no other way to reasonably acquire sufficient data is available. This study analyzed human stampede events from 1980 to 2007 to identify epidemiological characteristics associated with increased mortality.

Methods: A LexisNexis search was followed by sequential searches of multiple Internet-based English-language news agencies. Date, country, geographical region, time of occurrence, type of event, location, mechanism, number of participants, number injured, and number of deaths were recorded. Bivariate analyses of number of deaths or injuries were conducted using a nonparametric Wilcoxon rank test. Multivariate regression was performed to determine the factors associated with increased number of fatalities during stampede events.

Results: A total of 215 human stampede events were reported from 1980 to 2007, resulting in 7069 deaths and at least 14,078 injuries from 213 events with available fatality information and 179 events with injury information. In bivariate analysis, stampedes occurring in the Middle East, in developing countries, outdoors, or associated with religious events had the highest median number of deaths. In multivariate analysis, events that occurred in developing countries and outdoors were associated with increased number of fatalities. Stampedes that occurred in the context of sports, religious, music, and political events, or that had a unidirectional mechanism, also increased the relative number of deaths.

Conclusions: Several epidemiological features of human stampedes associated with increased mortality are identified. Standardized collection of epidemiological data pertaining to human stampedes is strongly recommended, and further study of this recurrent, distinctive disaster is warranted. (Disaster Med Public Health Preparedness. 2009;3:217–223)

The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health into disaster and emergency preparedness and response activities. One vital opportunity to improve integration is the development of clear and directive national policy to firmly establish the role of mental and behavioral health as part of a unified public health and medical response to disasters. Integration of mental and behavioral health into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services, addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.

(Disaster Med Public Health Preparedness. 2012;6:60–66)

As the rate of terrorism increases, it is important for health care providers to become familiar with the management of injuries inflicted by blasts and explosions. This article reviews the ocular injuries associated with explosive blasts, providing basic concepts with which to approach the blast-injured patient with eye trauma. We conducted a literature review of relevant articles indexed in PubMed between 1948 and 2007. Two hundred forty-four articles were reviewed. We concluded that ocular injury is a frequent cause of morbidity in blast victims, occurring in up to 28% of blast survivors. Secondary blast injuries, resulting from flying fragments and debris, cause the majority of eye injuries among blast victims. The most common blast eye injuries include corneal abrasions and foreign bodies, eyelid lacerations, open globe injuries, and intraocular foreign bodies. Injuries to the periorbital area can be a source of significant morbidity, and ocular blast injuries have the potential to result in severe vision loss.

(Disaster Med Public Health Preparedness. 2010;4:154-160)

Background: Despite increased government and public awareness of the threat of a radiological emergency resulting from a terrorist attack or industrial accident, limited emphasis has been placed on preparing the US health care workforce for such an event. The purpose of this study was to develop and apply a rapid survey to evaluate hospital-based nurses' baseline knowledge, self-assessed clinical competence, perception of personal safety, and willingness to respond in the event of a radiological emergency.

Methods: The study was conducted in 2 phases, the first targeting nursing units likely to respond in the event of a radiological emergency and the second focusing more generally on members of the New York State Emergency Nurses Association currently employed as hospital-based nurses.

Results: Among the 668 nurses surveyed, baseline knowledge was found to be inadequate. Although baseline knowledge, clinical competence, and perception of personal safety were all positively associated with willingness to respond, perception of safety appeared to be the primary determinant. Furthermore, baseline knowledge did not appear to be strongly associated with perception of personal safety.

Conclusions: Based on these results, the investigators recommend further clinical training to enhance preparedness and a more detailed exploration of the determinants of perceived personal safety. (Disaster Med Public Health Preparedness. 2008;2:224–229)

Multiple professional societies, nongovernment and government agencies have studied the science of sudden onset disaster mass casualty incidents to create and promote surge response guidelines. The COVID-19 pandemic has presented the health-care system with challenges that have limited science to guide the staff, stuff, and structure surge response.

This study reviewed the available surge science literature specifically to guide an emergency department’s surge structural response using a translational science approach to answer the question: How does the concept of sudden onset mass casualty incident surge capability apply to the process to expand COVID-19 pandemic surge structure response?

The available surge structural science literature was reviewed to determine the application to a pandemic response. The on-line ahead of print and print COVID-19 scientific publications, as well as gray literature were studied to learn the best available COVID-19 surge structural response science. A checklist was created to guide the emergency department team’s COVID-19 surge structural response.