We sought to systematically identify and analyze state-level legislative responses to Ebola from April 2014 through June 2015.

Using standardized search terms, we searched the LexisNexis State Capital database to identify bills or resolutions that explicitly mentioned Ebola or viral hemorrhagic fever in all 50 US states and Washington, DC, from April 2014 through June 2015. Information was abstracted from relevant bills or resolutions by using an electronic data collection form. Abstracted information was analyzed to identify themes and patterns.

Our search processes returned 273 bills and resolutions; 17 met our inclusion criterion. These 17 bills and resolutions were introduced in 11 states. The primary goals of these materials concerned the following: protecting or acknowledging public health and health care workers (n=4), revising the definition of “communicable disease” (n=3), financial considerations (n=5), establishing a task force (n=2), and updating or creating facilities (n=3). Six bills were enacted and 4 resolutions were adopted.

Approximately 20% of the states introduced bills or resolutions concerning the Ebola outbreak. These bills and resolutions highlight important practice considerations, including protections for those who assist in treating Ebola and revision of laws in the face of emerging infectious disease threats. Policy-makers and emergency planners would benefit from incorporating lessons learned from states’ Ebola responses into their preparedness activities. (Disaster Med Public Health Preparedness. 2016;10:649–653)

We aimed to evaluate residence in evacuation areas (storm areas) as a risk factor for food and waterborne disease (FWBD) associated with Hurricane Sandy flooding.

We captured 9601 incident outpatient and inpatient FWBD hospital discharge diagnoses for residents of the greater New York City area. We used Poisson or negative binomial regression models to compare the covariate-adjusted risk for a FWBD diagnosis, pre-Sandy (10/28-11/09, 2001-2011) vs. post-Sandy (10/28-11/09, 2012), for residents of “storm” and “non-storm” areas.

Outpatient FWBD risk was lower for storm area residents after Hurricane Sandy (risk ratio [RR]=0.58, 95% confidence interval [CI]: 0.46-0.74), and varied by age, sex, and county. However, storm area residents 65 years of age or older experienced higher risk after Hurricane Sandy (RR=2.16, 95% CI: 1.11-4.19), albeit based on few cases. Inpatient FWBD risk was lower for non-storm area residents after Hurricane Sandy (RR=0.79, 95% CI: 0.66-0.95), and varied by age, race, and county, although there was no significant change for storm area residents (RR=0.86, 95% CI: 0.69-1.08). Those ≥65 years of age were also at lower risk for inpatient FWBD diagnosis, yet the effect was weaker for storm area (RR=0.89, 95% CI: 0.67-1.18) than for non-storm area residents (RR=0.68, 95% CI: 0.52-0.89).

Hurricane preparation, mitigation, and response activities in the greater New York City area may have led to “protective” effects for FWBD. (Disaster Med Public Health Preparedness. 2016;10:503–511)

The West African Ebola epidemic has raised fundamental questions about the ethical and practical use of quarantine measures during infectious disease events.

This article first reviews the idea of containment in response to disease and the means by which containment has been perceived. It then proposes that disaster medicine, whose focus is the individual, and public health in its focus on populations have related but distinct ethical imperatives. The means by which both were deployed in the West African Ebola epidemic are considered.

The argument is made that a narrow focus on the individual patient or community prevented an early recognition of the potential for disease expansion. In this case, a broad public health perspective was overshadowed by localized attention.

In the future, a public health perspective is a necessary and ethical priority and thus the use of isolation and containment in conjunction with the imperative to treat that is the focus of medical ethics. (Disaster Med Public Health Preparedness. 2016;10:654–661)

Hurricane Sandy made landfall on October 29, 2012, causing a coastal storm surge and extensive flooding, which led to the closure of several health care facilities in New York City (NYC) and prolonged interruptions in service delivery. The impact on mental health–related emergency department (ED) and inpatient hospital service utilization was studied.

Data came from the New York Statewide Planning and Research Cooperative System. We obtained mental health–related data among NYC residents from 2010 to 2013. Patients were grouped into 5 geographic areas, including service areas of closed hospitals, the Hurricane Sandy evaluation zone, and all of NYC. The Farrington method was used to detect increases in ED visits and hospitalizations for the post-Sandy period.

Open hospitals experienced a substantial increase in psychiatric ED visits from patients living in the service areas of closed hospitals. This surge in psychiatric ED visits persisted for 4 to 6 months after Hurricane Sandy. However, the increase in psychiatric hospitalizations was observed for 1 to 3 months.

Several NYC hospitals received a substantially larger number of ED patients from service areas of closed hospitals after Hurricane Sandy, unlike other hospitals that experienced a decrease. Because of potential surges in the number of psychiatric ED visits, resource allocation to hospitals should be considered. (Disaster Med Public Health Preparedness. 2016;10:512–517)

The 2014 Ebola virus disease (EVD) outbreak in West Africa remains the most deadly in history. Emergency departments (EDs) are more likely to come into contact with potential EVD patients. It is important for EDs to be prepared to care for suspected EVD patients. Our objective was to understand the perceived challenges experienced by Washington State ED medical directors in EVD preparedness.

An anonymous, electronic survey was sent to a convenience sample of ED medical directors across Washington State between November and February of 2014–2015. The perceived challenges of and attitudes toward EVD preparations were assessed and reported as stratified proportions.

Of 85 medical directors contacted, 59 responses (69%) were received. This included EDs with annual patient volumes of <20,000 (20 hospitals, 34%), 20,000 to 40,000 (21 hospitals, 36%), 41,000 to 60,000 (4 hospitals, 6.8%), and >60,000 (12 hospitals, 20%). Among the perceived challenges in EVD preparations were spatial modifications (eg, building an anteroom for donning and doffing of personal protective equipment) and waste management planning. Ninety-five percent of respondents moderately or strongly agreed that it is important to have a predesignated hospital to care for EVD patients.

Washington State ED medical directors have faced significant challenges in ensuring their EDs are prepared to safely care for suspected EVD patients. Attitudes toward EVD preparations are mixed. Varying levels of perceived importance may represent an additional barrier to statewide EVD preparedness. (Disaster Med Public Health Preparedness. 2016;10:662–668)

Our aim was to examine in what terms leading newspapers’ online sites described the current Ebola crisis.

We employed a quantitative content analysis of terms attributed to Ebola. We found and analyzed 582 articles published between March 23 and September 30, 2014, on the online websites of 3 newspapers: The New York Times, Daily Mail, and Ynet. Our theoretical framework drew from the fields of health communication and emerging infectious disease communication, including such concepts as framing media literacy, risk signatures, and mental models.

We found that outbreak and epidemic were used interchangeably in the articles. From September 16, 2014, onward, epidemic predominated, corresponding to when President Barack Obama explicitly referred to Ebola as an epidemic. Prior to Obama’s speech, 86.8% of the articles (323) used the term outbreak and only 8.6% (32) used the term epidemic. Subsequently, both terms were used almost the same amount: 53.8% of the articles (113) used the term outbreak and 53.3% (112) used the term epidemic.

Effective communication is crucial during public health emergencies such as Ebola, because language framing affects the decision-making process of social judgments and actions. The choice of one term (outbreak) over another (epidemic) can create different conceptualizations of the disease, thereby influencing the risk signature. (Disaster Med Public Health Preparedness. 2016;10:669–673)

We examined public perceptions of the risk of an Ebola outbreak, knowledge about transmission, and the factors associated with planned protective behavior, including willingness to vaccinate.

We conducted a cross-sectional telephone survey using random digit dialing of 750 members of the New Zealand public between February 12 and 19, 2015.

Most of the sample (72%) reported that they had been following news of the outbreak closely and 28% were concerned that there would be a large outbreak in New Zealand. High rates of planned protective behavior, in terms of avoiding contact with other people, were reported, with 23% reporting they would avoid going to work, 49% reporting they would avoid using public transport, 42% reporting they would avoid sending children to school, and 52% reporting they would avoid public events. A younger age, a higher concern, and lower confidence in the ability of hospitals to contain the outbreak were significantly associated with both a greater willingness to vaccinate and a larger number of protective behaviors.

An Ebola outbreak would have large social and economic consequences owing to the large proportion of the population who intended to avoid social contact in order to protect their health. (Disaster Med Public Health Preparedness. 2016;10:674–680)

Using the example of surveys conducted by the American College of Emergency Physicians (ACEP) regarding the management of Ebola cases in the United States, we aimed to demonstrate how survey-based information networks can provide timely data to inform best practices in responding to public health emergencies.

ACEP conducted 3 surveys among its members in October to November 2014 to assess the state of Ebola preparedness in emergency departments. We analyzed the surveys to illustrate the types of information that can be gleaned from such surveys. We analyzed qualitative data through theme extraction and collected quantitative results through cross-tabulations and logistic regression examining associations between outcomes and potential contributing factors.

In the first survey, most respondents perceived their hospital as being reasonably prepared for Ebola. The second survey revealed significant associations between a hospital’s preparedness and its perceived ability to admit Ebola patients. The third survey identified 3 hospital characteristics that were significantly and independently associated with perceived ability to admit Ebola patients: large size, previous Ebola screening experience, and physician- and nurse-led hospital preparedness.

Professional associations can use their member networks to collect timely survey data to inform best practices during and immediately after public health emergencies. (Disaster Med Public Health Preparedness. 2016;10:681–690)