The key to resilience after disasters is the provision of coordinated care and resource distribution to the affected community. Past research indicates that the general public lacks an understanding regarding agencies’ roles and responsibilities during disaster response.

This study’s purpose was to explore the general public’s beliefs regarding agencies or organizations’ responsibilities related to resource management during disasters. In addition, the public’s attitudes towards the management and use of community disaster assistance centers were explored.

Qualitative interviews were conducted with members of the general public. Interviews were audio-recorded and transcribed verbatim. Content analysis was used to analyze the data and identify themes that describe the public’s expectations of disaster response agencies and the use of community disaster assistance centers.

A total of 28 interviews were conducted. Half of the participants (n=14) were black, 57% (n=16) were female, and the mean age was 49 years. The general public has developed trust and distrust toward response organizations and governmental agencies based on past experiences during disasters. The public wishes to have local agencies to help lead disaster response, but expects a collaboration between all response organizations, including the government. The managing agency overseeing community disaster assistance centers was not perceived as important, but the proximity of these centers to community members was considered critical.

The general public prefers that local agencies and leaders manage disaster response, and they expect collaboration among response agencies. Community assistance centers need to be located close to those in need, and be managed by agencies trusted by the general public. (Disaster Med Public Health Preparedness. 2018;12:446–449)

To investigate the extent to which older residents feel they can remain “self-reliant” during future natural disasters and to compare the findings with the viewpoints of local policy-makers and with those charged with caring for the elderly both on a day-to-day basis and in times of crisis.

This study used an array of non-probability snowballing techniques to seek the participation of senior citizens over the age of 65 years, emergency services officers, community health carers, and local government disaster managers located in aging, remote, coastal Australian communities vulnerable to cyclones and storm surges. All respondents participated in either a face-to-face personal interview or a focus group, with senior citizens also completing a self-administered questionnaire.

This research found a discrepancy between policy expectations and the experiences of both the elderly and those who care for them, as well as a lack of understanding with regard to the term “self-reliant.”

These results highlight the inability of older adults in aging, remote, coastal Australian communities to remain “self-reliant” in the future, impacting both disaster management policies and the future capacity of these communities to remain resilient. (Disaster Med Public Health Preparedness. 2018;12:14–18)

In a population with prior exposure to the World Trade Center (WTC) disaster, this study sought to determine the relationship between Hurricane Sandy-related inhalation exposures and post-Sandy lower respiratory symptoms (LRS).

Participants included 3835 WTC Health Registry enrollees who completed Wave 3 (2011-2012) and Hurricane Sandy (2013) surveys. The Sandy-related inhalational exposures examined were: (1) reconstruction exposure; (2) mold or damp environment exposure; and (3) other respiratory irritants exposure. LRS were defined as wheezing, persistent cough, or shortness of breath reported on ≥1 of the 30 days preceding survey completion. Associations between LRS and Sandy exposures, controlling for socio-demographic factors, post-traumatic stress disorder, and previously reported LRS and asthma were examined using multiple logistic regression.

Over one-third of participants (34.4%) reported post-Sandy LRS. Each of the individual exposures was also independently associated with post-Sandy LRS, each having approximately twice the odds of having post-Sandy LRS. We found a dose-response relationship between the number of types of Sandy-related exposures reported and post-Sandy LRS.

This study provides evidence that post-hurricane clean-up and reconstruction exposures can increase the risk for LRS. Public health interventions should emphasize the importance of safe remediation practices and recommend use of personal protective equipment. (Disaster Med Public Health Preparedness. 2018;12:697-702)

The World Stroke Organization “1 in 6” campaign aims to raise awareness that 1 in 6 persons will experience a stroke during their lifetime. With aging populations and improved survival rates, an increased number of survivors live with functional limitations and require supportive care. This has important implications for implementing an all-of-society approach to disaster risk reduction. In this study, we explore the assets that stroke survivors and caregivers consider useful in supporting their capacity to manage routine activities and independent living and to respond to a disaster.

Transcripts from interviews with stroke survivors and caregivers were analyzed by use of content analysis.

Assets were categorized into 4 classes: social, physical, energy, and personal characteristics and are presented as a household map. Emergent themes suggested that understanding how to mobilize assets is complicated yet essential for building resilience. Household resilience requires people have self-efficacy and motivation to move from awareness to action. The findings informed development of a conceptual model of asset literacy and household resilience following stroke.

Interventions to enhance asset literacy can support an all-of-society approach to disaster risk reduction through awareness, empowerment, participation, innovation, and engagement. (Disaster Med Public Health Preparedness. 2018; 12: 312–320)

First responders, including firefighters, police officers, emergency medical services, and company emergency response team members, have dangerous jobs that can bring them in contact with hazardous chemicals among other dangers. Limited information is available on responder injuries that occur during hazardous chemical incidents.

We analyzed 2002-2012 data on acute chemical incidents with injured responders from 2 Agency for Toxic Substances and Disease Registry chemical incident surveillance programs. To learn more about such injuries, we performed descriptive analysis and looked for trends.

The percentage of responders among all injured people in chemical incidents has not changed over the years. Firefighters were the most frequently injured group of responders, followed by police officers. Respiratory system problems were the most often reported injury, and the respiratory irritants, ammonia, methamphetamine-related chemicals, and carbon monoxide were the chemicals more often associated with injuries. Most of the incidents with responder injuries were caused by human error or equipment failure. Firefighters wore personal protective equipment (PPE) most frequently and police officers did so rarely. Police officers’ injuries were mostly associated with exposure to ammonia and methamphetamine-related chemicals. Most responders did not receive basic awareness-level hazardous material training.

All responders should have at least basic awareness-level hazardous material training to recognize and avoid exposure. Research on improving firefighter PPE should continue. (Disaster Med Public Health Preparedness. 2018;12:211–221)

To evaluate resilience and frequency of behavioral symptoms in Haitian children internationally adopted before and after the earthquake of January 12, 2010.

We conducted a retrospective quantitative study in 40 Haitian children. Families were also asked to participate in a qualitative study (individual interview at 18-24 months after the earthquake) and to complete State-Trait Anxiety Inventory (STAI) and STAI for children (STAI-C) questionnaires.

Demographic and clinical characteristics were similar in the group who experienced the earthquake (n=22) and in the group who did not (n=18). The families of 30 adoptees were interviewed. There was no statistical difference between the two groups for the STAI (P=0.53) and STAI-C (P=0.75) or for the frequency of behavioral problems. Plenary adoption was pronounced for 84.6% and 33.3% of the children adopted in the pre- and post-earthquake group, respectively (P=0.02). Children rarely talked about the experience of the earthquake, which, by contrast, was a stressful experience for the adoptive families.

Haitian children adopted after the earthquake did not express more stress or behavioral problems than those adopted before it. However, the possibility of a resurgence of mental disorders after age 10 should be borne in mind. (Disaster Med Public Health Preparedness. 2018;12:450–454)

Preparing and responding to the needs of children during public health emergencies continues to be challenging. The purpose of this study was to assess the usefulness of a tabletop exercise in initiating pediatric preparedness strategies and assessing the impact of the exercise on participants’ understanding of and confidence in their roles during pediatric public health emergencies.

A tabletop exercise was developed to simulate a public health emergency scenario involving smallpox in a child, with subsequent spread to multiple states. During the exercise, participants discussed and developed communication, collaboration, and medical countermeasure strategies to enhance pediatric public health preparedness. Exercise evaluation was designed to assess participants’ knowledge gained and level of confidence surrounding pediatric public health emergencies.

In total, 22 participants identified over 100 communication and collaboration strategies to promote pediatric public health preparedness during the exercise and found that the most beneficial aspect during the exercise was the partnership between pediatricians and public health officials. Participants’ knowledge and level of confidence surrounding a pediatric public health emergency increased after the exercise.

The tabletop exercise was effective in identifying strategies to improve pediatric public health preparedness as well as enhancing participants’ knowledge and confidence surrounding a potential pediatric public health emergency. (Disaster Med Public Health Preparedness. 2018;12:582–586)

To determine the ability of a novel responder mental health self-triage system to predict post-traumatic stress disorder (PTSD) in emergency medical responders after a disaster.

Participants in this study responded to Typhoon Haiyan, which struck the Philippines in November 2013. They completed the Psychological Simple Triage and Rapid Treatment (PsySTART) responder triage tool, the PTSD Checklist (PCL-5) and the Patient Health Questionnaire-8 (PHQ-8) shortly after responding to this disaster. The relationships between these 3 tools were compared to determine the association between different risk exposures while providing disaster medical care and subsequent levels of PTSD or depression.

The total number of PsySTART responder risk factors was closely related to PCL-5 scores ≥38, the threshold for clinical PTSD. Several of the PsySTART risk factors were predictive of clinical levels of PTSD as measured by the PCL-5 in this sample of deployed emergency medical responders.

The presence of a critical number and type of PsySTART responder self-triage risk factors predicted clinical levels of PTSD and subclinical depression in this sample of emergency medical workers. The ability to identify these disorders early can help categorize an at-risk subset for further timely “stepped care” interventions with the goals of both mitigating the long-term consequences and maximizing the return to resilience. (Disaster Med Public Health Preparedness. 2018;12:19–22)

We aimed to identify the differences in personal disaster preparedness and disaster risk perception among child care and preschool teachers in South Korea by using demographic characteristics and disaster-related questions.

A cross-sectional self-reporting questionnaire was administered from February to October 2014.

Of all the participants, 68.1% had received disaster preparedness education and training on 2 or more occasions per year; 13.2% had received no education or training. Personal disaster preparedness differed significantly by marital status (P<0.05), the number of disaster education and training sessions attended (P<0.05), and having purchased home insurance (P<0.001). Disaster risk perception differed significantly by children’s age group under a teacher’s care (P<0.05). The topic on which child care teachers wanted more training was “fractures and bleeding emergency care” (53.9%). The most probable disaster was considered to be a typhoon (66.0%).

Disaster preparedness is important for both young children and their teachers. Field-based teacher disaster preparedness education and training should be provided so that they can respond effectively to disaster occurrence regardless of type, time, or location. (Disaster Med Public Health Preparedness. 2018; 12: 321–328)

A disaster is a consequence of natural hazards and terrorist acts, which have significant potential to disrupt the entire wireless communication infrastructure. Therefore, the essential rescue squads and recovery operations during a catastrophic event will be severely debilitated. To provide efficient communication services, and to reduce casualty mortality and morbidity during the catastrophic events, we proposed the Tethered Balloon technology for disaster preparedness, detection, mitigation, and recovery assessment.

The proposed Tethered Balloon is applicable to any type of disaster except for storms. The Tethered Balloon is being actively researched and developed as a simple solution to improve the performance of rescues, facilities, and services of emergency medical communication in the disaster area. The most important requirement for rescue and relief teams during or after the disaster is a high quality of service of delivery communication services to save people’s lives.

Using our proposed technology, we report that the Tethered Balloon has a large disaster coverage area. Therefore, the rescue and research teams are given higher priority, and their performance significantly improved in the particular coverage area.

Tethered Balloon features made it suitable for disaster preparedness, mitigation, and recovery. The performance of rescue and relief teams was effective and efficient before and after the disaster as well as can be continued to coordinate the relief teams until disaster recovery. (Disaster Med Public Health Preparedness. 2018;12:222–231)

China’s emergency management of severe acute respiratory syndrome (SARS) was heavily criticized, whereas the H7N9 response was praised by the international community.

The aims of this study were to examine and compare the strengths and weaknesses of risk communication conducted in response to SARS and H7N9 and their associated social impacts on affected communities in China.

A qualitative comparative case study approach was employed in the present study, using a set of 8 risk communication principles selected from international literature to suit the Chinese context for the comparative analysis of emergency responses of SARS and H7N9.

The study found significant differences in the risk communication conducted in the 2 cases. The SARS outbreak fully exposed China’s lack of experience in public health risk communication. By contrast, the Chinese government’s risk communication strategies had improved significantly during the H7N9 outbreak.

Trust is the basis for communication. Maintaining an open and honest attitude and actively engaging stakeholders to address their risk information needs will serve to build trust and facilitate multi-sector collaborations in dealing with a public health crisis.

From SARS to H7N9, risk communication practices in China greatly improved, which, in turn, lessened adverse social impacts and improved outcomes in emergency management of public health crises. (Disaster Med Public Health Preparedness. 2018;12:587–598)

A common method of disaster training is needed to improve disaster nursing education and facilitate better communication among interprofessional disaster responders. To inform the development of disaster nursing curricula, a novel disaster nursing education method consistent with Homeland Security Exercise and Evaluation Program (HSEEP) and the International Council of Nurses (ICN) framework was developed to improve disaster nursing competencies in a baccalaureate nursing program.

In total, 89 undergraduate nursing students participated. Perceived disaster nursing knowledge, confidence, and training/response were assessed with 14 items before and after the education.

Exploratory factor analysis showed 3 factors, knowledge, confidence, and training/response, explained 71% of variation in items. Nursing students showed large improvements in perceived disaster nursing knowledge (t=11.95, P<0.001, Cohen’s d=1.76), moderate increases in perceived confidence (t=4.54, P<0.001, d=0.67), and no change in disaster training and response (t=0.94, P=0.351, d=0.13).

Results show preliminary evidence supporting the effectiveness of disaster nursing education informed by HSEEP. This training has the potential to fill current practice gaps in disaster nursing knowledge and build confidence to use those skills in practice. (Disaster Med Public Health Preparedness. 2018;12:703-710)

The objective of this study was to assess the adverse health symptoms experienced by adult subjects who were exposed to benzene after a flaring disaster at the BP refinery in Texas City, Texas.

A total of 2162 adults aged 18 years or older and exposed to benzene were included. Using the patients’ medical charts, we collected and analyzed data on health complaints as well as the patients’ serum levels of beta-2-microglobulin and urinary excretion of phenol.

A total of 11,368 health symptom complaints were reported in 2162 adults exposed to benzene. Neurological symptoms occurred most frequently (174%), followed upper respiratory symptoms (115%), cough (31%), painful joints (30%), cardiac symptoms (28%), dermatological symptoms (28%), gastrointestinal symptoms (27%), diarrhea (25%), vision symptoms (21%), and nausea/vomiting (19%). Logistic regression analysis indicated that urinary symptoms (R2=0.65) and painful joints (R2=0.44) were positively associated with increasing age in benzene-exposed subjects.

Adult subjects exposed to benzene experience a range of adverse health symptoms and an altered profile of urinary phenol, thus indicating they are at high risk of developing serious future health complications. (Disaster Med Public Health Preparedness. 2018;12:232–240)

This study aimed to examine factors associated with receipt of post-disaster support from network (eg, family or friends) and non-network (eg, government agencies) sources.

Participants (n=409) were from a population-based sample of Hurricane Sandy survivors surveyed 25-28 months post-disaster. Survivors were asked to imagine a future disaster and indicate how much they would depend on network and non-network sources of support. In addition, they reported on demographic characteristics, disaster-related exposure, post-traumatic stress, and depression. Information on the economic and social resources in survivors’ communities was also collected.

Multilevel multivariable regression models found that lack of insurance coverage and residence in a neighborhood wherein more persons lived alone were associated with survivors anticipating less network and non-network support. In addition, being married or cohabiting was significantly associated with more anticipated network support, whereas older age and having a high school education or less were significantly associated with less anticipated network support.

By having survivors anticipate a future disaster scenario, this study provides insight into predictors of post-disaster receipt of network and non-network support. Further research is needed to examine how these findings correspond to survivors’ received support in the aftermath of future disasters. (Disaster Med Public Health Preparedness. 2018;12:711-717)

The objective of this study was to develop and evaluate an evidence-based information technology (IT) application that guides clinical decision-making during the reverse-triage selection process in mass casualty incidents.

Based upon 28 validated critical interventions (CI) relevant for determining whether a patient qualifies for early discharge, we developed the Reverse Triage Tool of Leuven (RTTL). The RTTL is compatible with the health electronic record (HER) of UZ Leuven, a tertiary hospital in Belgium. During a 3-week period in March 2015, we registered data from 2 groups of patients: a random group (no RTTL usage) and a filtered group (RTTL usage).

When applying the original 28 CIs, we were able to select almost twice as many patients in the filtered group who qualified for early discharge compared with patients in the random group. The predictive validity was highly satisfactory.

The RTTL saves time in 2 ways. First, it reduces the patient population that needs to be evaluated for potential early discharge to one-third. Second, it doubles the probability of selecting an actual dischargeable patient. Each selected patient, however, still must undergo multidisciplinary reassessment in order to qualify for early discharge. Thus, further research is required to optimize the IT application.(Disaster Med Public Health Preparedness. 2018;12:599–605)

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)

Social media provides us with a new platform on which to explore how the public responds to disasters and, of particular importance, how they respond to the emergence of infectious diseases such as Ebola. Provided it is appropriately informed, social media offers a potentially powerful means of supporting both early detection and effective containment of communicable diseases, which is essential for improving disaster medicine and public health preparedness.

The 2014 West African Ebola outbreak is a particularly relevant contemporary case study on account of the large number of annual arrivals from Africa, including Chinese employees engaged in projects in Africa. Weibo (Weibo Corp, Beijing, China) is China’s most popular social media platform, with more than 2 billion users and over 300 million daily posts, and offers great opportunity to monitor early detection and promotion of public health awareness.

We present a proof-of-concept study of a subset of Weibo posts during the outbreak demonstrating potential and identifying priorities for improving the efficacy and accuracy of information dissemination. We quantify the evolution of the social network topology within Weibo relating to the efficacy of information sharing.

We show how relatively few nodes in the network can have a dominant influence over both the quality and quantity of the information shared. These findings make an important contribution to disaster medicine and public health preparedness from theoretical and methodological perspectives for dealing with epidemics. (Disaster Med Public Health Preparedness. 2018;12:26–37)

To assess the level of all-hazards disaster preparedness and training needs of emergency department (ED) doctors and nurses in Hong Kong from their perspective, and identify factors associated with high perceived personal preparedness.

This study was a cross-sectional territory-wide online survey conducted from 9 September to 26 October, 2015.

The participants were doctors from the Hong Kong College of Emergency Medicine and nurses from the Hong Kong College of Emergency Nursing.

We assessed various components of all-hazards preparedness using a 25-item questionnaire. Backward logistic regression was used to identify factors associated with perceived preparedness.

A total of 107 responses were analyzed. Respondents lacked training in disaster management, emergency communication, psychological first aid, public health interventions, disaster law and ethics, media handling, and humanitarian response in an overseas setting. High perceived workplace preparedness, length of practice, and willingness to respond were associated with high perceived personal preparedness.

Given the current gaps in and needs for increased disaster preparedness training, ED doctors and nurses in Hong Kong may benefit from the development of core-competency-based training targeting the under-trained areas, measures to improve staff confidence in their workplaces, and efforts to remove barriers to staff willingness to respond. (Disaster Med Public Health Preparedness. 2018; 12: 329–336)