The coronavirus disease (COVID-19) pandemic has presented unique challenges to pediatric emergency medicine (PEM) departments. The purpose of this study was to identify these challenges and ascertain how centers overcame barriers in creating solutions to continue to provide high-quality care and keep their workforce safe during the early pandemic.

This is a qualitative study based on semi-structured interviews with physicians in leadership positions who have disaster or emergency management experience. Participants were identified through purposive sampling. Interviews were recorded and transcribed electronically. Themes and codes were extracted from the transcripts by 2 independent coders. Constant comparison analysis was performed until thematic saturation was achieved. Member-checking was completed to ensure trustworthiness.

Fourteen PEM-trained physicians participated in this study. Communication, leadership and planning, clinical practice, and personal adaptations were the principal themes identified. Recommendations elicited include improving communication strategies; increasing emergency department (ED) representation within hospital-wide incident command; preparing for a surge and accepting adult patients; personal protective equipment supply and usage; developing testing strategies; and adaptations individuals made to their practice to keep themselves and their families safe.

By sharing COVID-19 experiences and offering solutions to commonly encountered problems, pediatric EDs may be better prepared for future pandemics.

Mine rescue teams bear a high risk of injury. To improve medical emergency preparedness and injury prevention, this work analyzed the causes and severity of mine rescue teams’ casualty incidents, the primary injuries, and the link between the causes and the occurrences of the casualty incidents.

A total of 81 cases from 1953 to 2013 were used to analyze the casualty incidents of mine rescue teams based on the frequency of accidents. A panel with 4 rescue experts was set up to ensure the accuracy of the analysis.

The 81 casualty incidents occurred in 7 types of rescue work and were due to 6 causes. Organizational and personal factors were the leading cause, followed by rescue skill and equipment factors. Problems with decision-making and command have gradually become the primary inducement of casualty incidents in recent years, with an average death toll reaching up to 6 to 7 people. The main injuries causing death to team members were blast injury, burns, poisoning, suffocation, blunt trauma, and overwork injury. Some of the injured died because of medical emergency response failure.

The construction of emergency medical teams and the preparedness of disaster medicine need to be improved to reduce the mortality of the injured team members. Actions according to the causes of casualty incidents should be adopted for injury prevention. (Disaster Med Public Health Preparedness. 2019;13:695–699)

An effective way to reduce casualties from earthquakes is to increase population preparedness. During 2011 to 2013, Israeli authorities executed 3 national-level earthquake awareness campaigns. We aimed to assess the impact of these campaigns on the populace and the ability of the campaigns to produce a cumulative effect throughout the study period.

Two surveys were conducted 2 weeks after the end of the first campaign and the third campaign in a similar randomly selected representative sample.

Exposure to the campaign proved to be a significant factor in increasing the knowledge of the respondents, giving a knowledge advantage of 1.5 times to respondents exposed to the campaign. However, the period of assessment proved to be an even more significant factor, with knowledge in 2013 being 2.3 times that in 2011. Additionally, a gap of up to 40% between the levels of trust and the perceived responsibility of respective authorities in the times of earthquake was found.

This study found an improvement in public knowledge regarding earthquake preparedness over the 3 years of the study. This may mean that an awareness campaign does not stand by itself, but should be part of an integrated long-term process in order to have a lasting effect on the population. (Disaster Med Public Health Preparedness. 2016;10:74–79)

We examined psychological outcomes in a sample of participants who evacuated from the World Trade Center towers on September 11, 2011. This study aimed to identify risk factors for psychological injury that might be amenable to change, thereby reducing adverse impacts associated with emergency high-rise evacuation.

We used data from a cross-sectional survey conducted 2 years after the attacks to classify 789 evacuees into 3 self-reported psychological outcome categories: long-term psychological disorder diagnosed by a physician, short-term psychological disorder and/or memory problems, and no known psychological disorder.

After nonmodifiable risk factors were controlled for, diagnosed psychological disorder was more likely for evacuees who reported lower “emergency preparedness safety climate” scores, more evacuation challenges (during exit from the towers), and evacuation-related physical injuries. Other variables associated with increased risk of psychological disorder outcome included gender (female), lower levels of education, preexisting physical disability, preexisting psychological disorder, greater distance to final exit, and more information sources during egress.

Improving the “emergency preparedness safety climate” of high-rise business occupancies and reducing the number of egress challenges are potential strategies for reducing the risk of adverse psychological outcomes of high-rise evacuations. Focused safety training for individuals with physical disabilities is also warranted. (Disaster Med Public Health Preparedness. 2017;11:326–336)

Typhoon Haiyan partially destroyed the Ormoc District Hospital in the Philippines. A field hospital was established to replace its outpatient department for 5 weeks. We investigated the reasons for medical consultation in the field hospital.

We described the consultations by sex, age, week, and diagnosis according to the Surveillance in Post-Extreme Emergencies and Disasters system. We compared the number and proportion of upper respiratory tract infections (URTIs) with a control season in 2014.

We included 6785 consultations, 55.9% from women. The majority of consultations were communicable diseases (88.2%) followed by noncommunicable (7.1%) and injuries (5.6%). Males suffered more often from injuries than women (66.0% vs 34.0%). Consultations due to injuries decreased from 10.0% in the first to 2.9% in the last week. The most frequent diagnosis over the study period was acute respiratory infections (ARIs) (73.1%), of which 83.0% were children. The number of daily URTIs was higher than in a similar 2014 period.

ARI was the most prevalent diagnosis. We recommend ARI treatments being fully accessible after such a disaster. During the first week, injury prevention should focus on adult men. Studies after natural disasters should include control periods to better understand disease distribution, ultimately improving the prioritization in disasters.

The Indian subcontinent is prone to tropical cyclones that used to originate in the North Indian Ocean. Through this study, an inventory of disease outbreaks for the tropical cyclone-affected regions from 2010 to 2018 has been compiled. This inventory is used to assess the success of recent sanitation intervention, Swachh Bharat Mission, also known as the Clean India Mission.

Meteorological parameters from the Indian satellites were used to demarcate the cyclone-affected area. Disease outbreaks and epidemics during the tropical cyclones were compiled from the Integrated Disease Surveillance Program and other relevant sources. The inventory has been used to track the effect of recent sanitation interventions on disease outbreaks.

Districts in the eastern coast of India are frequently affected due to tropical cyclones that have originated from the North Indian Ocean. Infectious diseases like the acute diarrheal diseases, vector-borne diseases, viral fevers, enteric fevers, and food poisoning have recursively occurred during the cyclonic events and persisted up to 2 weeks from the cyclonic episode. The effectiveness of the Clean India Mission is evident during the recent cyclones, Ockhi, Titli, and Gaja, where a significantly lower number of infectious disease outbreaks were recorded.

The Clean India Mission has exhibited positive results on the public health consequences associated with tropical cyclones.

Information on surges in critical care services including mechanical ventilator use during seasonal influenza outbreaks is limited. To potentially facilitate preparedness plans for future pandemics, we retrospectively quantitated surges in all-cause mechanical ventilator use during peak influenza for 12 consecutive years in all certified hospitals in Maryland.

Influenza testing data obtained for the Centers for Disease Control and Protection, Health and Human Services region 3, included defined peak influenza outbreak periods (PIOP), non-influenza time periods (non-ITP), and proportions of circulating influenza types for all study years. Procedure codes for mechanical ventilator use and diagnostic codes for medically attended acute respiratory illness (MAARI) were reviewed for every Maryland hospitalization. Daily counts of hospitalizations associated with ventilator use or MAARI during PIOP compared to non-ITP were analyzed using Poisson regression adjusted for month and year.

Ventilator use increased during PIOP by 7% (95% CI, 5-10) over non-ITP (P < .0001) for all study years. These annual surges correlated with influenza season intensity, as measured by MAARI-related hospitalizations (correlation coefficient = 0.91, P < .0001).

Surges in ventilator use were temporally associated with PIOP and were positively correlated with influenza season intensity, as measured by hospitalizations associated with acute respiratory illness. This information may assist resource planning for future pandemics. (Disaster Med Public Health Preparedness. 2014;x:1-7)

The 2011 Fukushima Daiichi nuclear accident was the worst nuclear disaster since Chernobyl. The Daiichi workers faced multiple stressors (workplace trauma, victim experiences, and public criticism deriving from their company’s post-disaster management). Literatures suggest the importance of workplace interpersonal support (WIS) in enhancing psychological health among disaster workers. We sought to elucidate the role of their demographics, disaster-related experiences, and post-traumatic stress symptoms on perceived WIS.

We analyzed self-report questionnaires of 885 workers 2-3 months post-disaster. We used sociodemographic and disaster exposure-related variables and post-traumatic stress symptoms (measured by the Impact of Event Scale-Revised) as independent variables. We asked whether WIS from colleagues, supervisors, or subordinates was perceived as helpful, and used yes or no responses as a dependent variable. Logistic regression analyses were performed to assess correlates of WIS.

Of the participants, one-third (34.7%) reported WIS. WIS was associated with younger age (20-28 years [vs 49-], adjusted odds ratio [aOR]: 3.25, 95% CI: 1.99-5.32), supervisory work status (aOR: 2.30, 95% CI: 1.35-3.92), and discrimination or slur experience (aOR: 1.65, 95% CI: 1.08-2.53).

Educational programs focusing on WIS might be beneficial to promote psychological well-being among nuclear disaster workers, especially younger workers, supervisors, and workers with discrimination experiences. (Disaster Med Public Health Preparedness. 2018;12:460–463)

Due to the common instability caused by political and security issues, Lebanese hospitals have experienced acts of terrorism multiple times. The most recent Beirut Explosion even forced several hospitals to cease operations for the first time in decades—but studies show the preparedness levels for such attacks in similar countries are low.

The aim of this study is to explore the experience of Lebanese hospitals with terrorist attacks.

This qualitative study used semi-structured interviews with various stakeholders to assess their experience with terrorist bombings. Data was analyzed using the thematic analysis method.

The researchers found that Lebanese hospitals vary greatly in their structures and procedures. Those differences are a function of 3 contextual factors: location, culture, and accreditation status. Hospitals found near ‘dangerous zones’ were more likely to be aware and to have better response to such events. A severe lack of communication, unity of command, and collaboration between stakeholders has made the process fragmented.

The researchers recommend a larger role for the Ministry of Public Health (MOPH) in this process, and the creation of a platform where Lebanese organizations can share their experiences to improve preparedness and resilience of the Lebanese healthcare system in the face of terrorism.

During 2009-2011, Pike County, Kentucky, experienced a series of severe weather events that resulted in property damage, insufficient potable water, and need for temporary shelters. A Community Assessment for Public Health Emergency Response (CASPER) survey was implemented for future planning. CASPER assesses household health status, preparedness level, and anticipated demand for shelters.

We used a 2-stage cluster sampling design to randomly select 210 representative households for in-person interviews. We estimated the proportion of households with children aged 2 years or younger; adults aged 65 years or older; and residents with chronic health conditions, visual impairments, physical limitations, and supplemental oxygen requirements.

Of all households surveyed, 8% included children aged 2 years or younger, and 27% included adults aged 65 years or older. The most common chronic health conditions were heart disease (51%), diabetes (28%), lung disease (23%), and asthma (21%). Visual impairments were reported in 29% of households, physical limitations in 24%, and supplemental oxygen use in 12%.

Pike County residents should be encouraged to maintain an adequate supply of medications and copies of their prescriptions. Emergency response plans should include transportation for persons with physical limitations; and shelter plans should include sufficient medically trained staff and adequate supplies of infant formula, pharmaceuticals, and supplemental oxygen. (Disaster Med Public Health Preparedness. 2013;7:597-602)