We quantified an absolute imbalance of the medical risks and the support needs for children at each disaster-based hospital in Kanagawa immediately following the occurrence of a large earthquake by using the risk resource ratio (RRR) and need for medical resources (NMR).

The RRR and NMR of 33 disaster-based hospitals were estimated through dividing the estimated number of pediatric victims by the number of critically patients. We calculated the ratio of the NMR of each hospital.

The total number of pediatric victims in Kanagawa was estimated at 8,391. The total number of vacant beds for pediatric victims was 352. The median RRR and NMR of the total number of pediatric victims were 27 and 224. The median RRR and NMR of the number of critically ill pediatric patients were 27 and 12.

The absolute imbalance of the RRR and NMR for children in Kanagawa was quantified. This suggests that we might embark on preparedness strategies for children in advance. (Disaster Med Public Health Preparedness. 2018;13:672–676)

The aim of this study was to identify regulations that were established and implemented as an emergency disaster response to intense rain and floods generated by the El Niño coastal phenomenon.

A search was conducted for the legal norms approved and published between December 1, 2016 and December 31, 2017, in El Peruano, Peru’s official newspaper. Twenty legal norms involved disaster emergency response, rehabilitation, and the reconstruction of the affected regions.

Forty-six legal norms were identified, of which 41% were aimed at the declaration of emergencies and alerts, 22% to facilitate the management of economic resources, and 13% for coordination actions. Sixty-two percent of the approved standards were set for the regional level, 22% for the national level, 7% for the municipal level, and the remaining 10% corresponded with more than 1 level of government.

The actions during and after the El Niño coastal phenomenon required the approval of standards included in the legal framework of Peru’s disaster risk management, as well as a large number of unforeseen standards to address existing regulatory gaps and specific problems that occurred during this natural disaster.

We analyzed research themes in the field of disaster medicine in China to provide references for researchers to understand the research status and developing trends of this field.

Published journal articles were retrieved. A social network analysis was conducted to visualize the relations of high-frequency key words. A cluster analysis was used to classify key words. A strategic diagram analysis was conducted to visualize clusters across the entire research field.

We retrieved 3,079 articles, from which 1,749 articles and 8,284 key words were identified after screening. High-frequency key words were classified into 6 clusters. “Medical rescue” had the highest degree and betweenness centralities. Cluster 4 was located in Quadrant I of the strategic diagrams.

“Medical rescue” is the core key word, and it serves a pivotal “bridge” function. “Emergencies” and similar terms are key words with special statuses. “Natural disaster medical rescue” and “fundamental theories of disaster medicine” constitute the primary and secondary core themes, respectively. “On-site emergency treatment techniques” is a marginalized theme. The other themes are emerging themes that offer considerable scope for future development. Generally, the scope and depth of investigations in this field should be improved. (Disaster Med Public Health Preparedness. 2019;13:405-409)

This pilot study aimed to assess the community needs and population health status for the low-income town of Punta Santiago, situated on the southeastern coast of Puerto Rico at the point where Hurricane Maria made landfall on September 20, 2017.

A cross-sectional, interviewer-administered survey was conducted 6 months after the storm with a representative random sample of 74 households. The survey characterized population demographics and resident needs in relation to storm damage and disruption. The survey also assessed prevalence and symptom severity of major depression, generalized anxiety, and posttraumatic stress disorder.

Most of Punta Santiago was without electrical power and more than half of households sustained severe damage. Residents reported loss of jobs, decreased productivity, school closures, dependency on aid for basic necessities, increased risk for vector-borne diseases, unrelenting exposure to heat and humidity, and diminished health status. Two-thirds (66.2%) of the respondents had clinically significant symptom elevations for at least 1 of the 3 common mental disorders assessed: major depression, generalized anxiety, or posttraumatic stress disorder.

Pilot survey results, along with other studies conducted in Punta Santiago, can be used to provide guidance for interventions with this community as well as with other low-income, storm-affected areas. (Disaster Med Public Health Preparedness. 2019;13:18–23)

Disability-related education is essential for disaster responders and critical care transporters to ensure positive patient outcomes. This pilot study evaluated the effect of an online educational intervention on disaster responders and critical care transporters’ knowledge of and feelings of self-efficacy about caring for individuals with developmental disabilities.

A 1-group, pretest-posttest, quasi-experimental design was used. A convenience sample of 33 disaster responders and critical care transporters participated.

Of the 33 participants, only 24% had received prior education on this topic, and 88% stated that such education would be beneficial to their care of patients. Nineteen participants completed both the pretest and posttest, and overall performance on knowledge items improved from 66% correct to 81% correct. Self-efficacy for caring for developmentally disabled individuals improved, with all 10 items showing a statistically significant improvement.

Online education is recommended to improve the knowledge and self-efficacy of disaster responders and critical care transporters who care for this vulnerable population after disasters and emergencies. (Disaster Med Public Health Preparedness. 2019;13:677–681)

In the summer of 2015, Beirut experienced a garbage crisis that led to rioting. Riot control measures resulted in multiple casualties. This study examines injury patterns of riot victims presenting to the emergency department of a tertiary care center in a developing country.

A retrospective study was conducted in the emergency department of the American University of Beirut Medical Center between August 22 and August 30, 2015. Patients seen in the emergency department with riot injuries were included. Patient characteristics, injuries, and resources utilized in the emergency department were analyzed.

Ninety-five patients were identified. Most patients presented to the emergency department within a short time period. The mean age of the patients was 28.0 ± 8.7 years. Most (90.5%) of the patients were males and 92.6% were protestors. Emergency medical services were utilized by 41.0% of patients. Laceration was the most common presenting complaint (28.5%), and blunt trauma was the most common type of injury (50.5%). The head/face/neck was the most common injured body region (55.8%). Most patients did not require blood tests or procedures (91.6% and 61.0%, respectively), and 91.2% of patients were treated in the emergency department and discharged. One patient required intensive care unit admission and another was dead on arrival.

Most patients had mild injuries on presentation. The emergency department experienced a high influx of patients. Complications and deaths can occur from seemingly nonlethal weapons used during riots and warrant effective prehospital and hospital disaster planning.

The aim of this study was to compare the effect of Hurricane Maria on internalizing and posttraumatic stress disorders (PTSD) among Puerto Ricans who moved to Florida after the storm versus those who stayed on the island.

In March through April 2018 (6 months after Hurricane Maria), an online survey was used to assess the effects of the storm on mental health. A sample of 213 displaced Puerto Ricans living in urban and rural/suburban areas in Florida, as well as urban and rural areas of Puerto Rico, participated in the study.

Rates of PTSD were high in both sites (Florida, 65.7%; Puerto Rico, 43.6%); however, participants in Florida were far more likely than those in Puerto Rico to meet diagnostic criteria for PTSD (OR, 2.94; 95% CI, 1.67-5.26). Among participants in both Florida and Puerto Rico, those living in urban areas were more likely than those in rural/suburban areas to meet criteria for PTSD and generalized anxiety disorder.

Results suggest that post-Hurricane Maria adjustment and adaptation may have been more psychologically taxing for Puerto Ricans who moved to Florida than it was for those who remained on the island, and more difficult for those in urban areas than it was for those in suburban or rural areas. (Disaster Med Public Health Preparedness. 2019;13:24–27)

Crises require a timely and well-prepared response by health services, especially those that are directly engaged with the lives of the patients such as blood services. The Iranian Blood Transfusion Organization as a single national authority of blood transfusion has left many crises behind. In this study, we examined the main international crises that the blood transfusion organization has faced during its 44-year history and objectively evaluated the methods for crisis risk reduction, both administrative and operational, all of which have led to fundamental advances in the organization. By proper planning and effective strategy setting, the Iranian Blood Transfusion Organization has managed to cope with international threats and in some cases has turned threats into opportunities to implement new, permanent administrative and operational strategies. It is not prudent for blood transfusion centers to develop their disaster risk reduction strategies on an individual-country basis in a world where global risk and crisis factors are rapidly increasing. Reduction of risk for blood transfusion centers must become a strategic priority nationally and globally. (Disaster Med Public Health Preparedness. 2019;13:410-413)

Eight million American children under the age of 5 attend daycare and more than another 50 million American children are in school or daycare settings. Emergency planning requirements for daycare licensing vary by state. Expert opinions were used to create a disaster preparedness video designed for daycare providers to cover a broad spectrum of scenarios.

Various stakeholders (17) devised the outline for an educational pre-disaster video for child daycare providers using the Delphi technique. Fleiss κ values were obtained for consensus data. A 20-minute video was created, addressing the physical, psychological, and legal needs of children during and after a disaster. Viewers completed an anonymous survey to evaluate topic comprehension.

A consensus was attempted on all topics, ranging from elements for inclusion to presentation format. The Fleiss κ value of 0.07 was obtained. Fifty-seven of the total 168 video viewers completed the 10-question survey, with comprehension scores ranging from 72% to 100%.

Evaluation of caregivers that viewed our video supports understanding of video contents. Ultimately, the technique used to create and disseminate the resources may serve as a template for others providing pre-disaster planning education. (Disaster Med Public Health Preparedness. 2019;13:123–127)

Immunization data are vital to support responses to vaccine-preventable disease outbreaks. The Oregon Immunization Program developed a unique prototype instrument—the Rapid Response Tool (RRT)—that provides population data to local responders within 2 hours of a request. Data outputs include vaccination coverage by age group and zip code; percentages of students with nonmedical exemptions to vaccination requirements, by school; and current, comprehensive lists of local vaccination providers.

The RRT was demonstrated to staff at 7 Oregon counties and feedback was solicited via comments and a structured survey.

The RRT received strong support. Attendees identified several uses for RRT data, including outbreak response and ongoing intervention efforts, and they pointed to areas for further development.

The success of the RRT demonstrations illustrates that a well-populated immunization information system can contribute to preparedness work well beyond current standards. (Disaster Med Public Health Preparedness. 2019;13:682–685)

Investigate short- and long-term effects of Superstorm Sandy on multiple morbidities among the elderly.

We examined emergency department visits; outpatient visits; and hospital admissions for cardiovascular disease (CVD), respiratory disease, and injury among residents residing in 8 affected counties immediately, 4 months, and 12 months following Superstorm Sandy. Control groups were defined as visits/admissions during the identical time window in the 5 years before (2007-2011) and 1 year after (2013-2014) the storm in affected and nonaffected counties in New York. We performed Poisson regression to test whether there was an association of increased visits/admissions for periods following Superstorm Sandy while controlling for covariates.

We found that the risk for CVD, respiratory disease, and injury visits/admissions was more than twice as high immediately, 4 months, and 12 months after the storm than it was in the control periods. Women were at greater risk at all time periods for CVD (risk ratio [RR], 2.04) and respiratory disease (RRs: 1.89 to 1.92). Whites had higher risk for CVD, respiratory disease, and injury than other racial groups during each period.

We observed increases in CVD, respiratory disease, and injury up to a year following Superstorm Sandy. Findings demonstrate the need to incorporate short- and long-term health effects into public health recovery. (Disaster Med Public Health Preparedness. 2019;13:28-32)

To identify the prevalence of posttraumatic stress disorder (PTSD) and its determinants among adolescents more than 4 years after the 2008 Wenchuan earthquake.

Adolescents (1,125 total) from 2 junior high schools in areas affected by the catastrophic earthquake were followed up for 3 years. The self-rating PTSD scale based on the Manual of Mental Disorders, 4th Edition (DSM-IV) and the Chinese Classification and Diagnostic Criteria of Mental Disorders, 2nd Edition, Revised (CCMD-2-R) was collected at 53 months, and determinant data were collected repeatedly. Logistic regression was used for a determinants analysis.

The prevalence of overall PTSD was 23.4% among the sample. The risk factors for PTSD were older age (OR=1.52, 95% CI: 1.20~1.92), and death or injury of a family member in the earthquake (OR=1.61, 95% CI: 1.09~2.37). Adolescents who had moderate-to-severe common mental health problems were more likely to have PTSD symptoms, with ORs from 3.98 to 17.67 (All P<0.05). Self-esteem remained a protective factor for PTSD regardless of age, whereas positive coping was a protective factor for PTSD when adolescents were older.

PTSD symptoms among adolescent survivors of a catastrophic earthquake seemed to persist over time. Long-term interventions are needed to alleviate PTSD symptoms among adolescent survivors. (Disaster Med Public Health Preparedness. 2019;13:414-418)

In Japan, with the revision of the Nuclear Emergency Response Guidelines in 2015, nuclear emergency medical assistance teams responsible for the medical treatment in the acute phase of nuclear disaster have been developed nationwide. The purpose of this research is to develop active learning materials for the education of medical staff, to confirm the educational effect of the materials, and to identify the gaps in nuclear disaster risk reduction in Japan.

We established a working group and created active learning materials. We trained members of the nuclear emergency medical assistance team using the developed active learning materials and then conducted a questionnaire survey for trainees who participated in the training.

Regarding the developed teaching materials, out of 33 trainees, 33 (100%) answered “easy to understand” or “a little understandable” to the item dealing with how to use the radiation detectors and attaching/detaching personal protective equipment. Regarding the simulation about practicing hospital support and medical provision, 3 (8%) answered “a little confusing.”

The study demonstrated that the developed materials have an educational effect. Additionally, the results of the trainee questionnaire showed the necessity for improvement in the triage system and new protocols to help both the patients and responders.

Earthquakes may lead to a reaction to severe stress and adjustment disorders (RSSAD). On September 7, 19, and 23, 2017, Mexico was struck by many severe earthquakes. The aim of this study was to examine whether there was an increase in the number of consultations and RSSAD in a psychiatric emergency department in Mexico City after these earthquakes.

We studied retrospectively the diagnosis and triage assessment from a Mexican psychiatric emergency department database from September 1 to November 30, 2017, and analyzed RSSAD and the number of consultations after the earthquakes.

A total of 1,811 psychiatric emergency consultations were registered from the period of study. A total of 141 consultations represented RSSAD. There was a significant increase of RSSAD after the September 23, 2017, earthquake. The triage assessment revealed that the urgency of the consultations was higher immediately after the earthquakes.

Natural disasters, such as earthquakes, may trigger diverse RSSAD leading to increased emergency consultations, especially when those disasters are repetitive. Mental health professionals should be adequately trained and sensitized for possible acute disaster victims. (Disaster Med Public Health Preparedness. 2019;13:686–690).

The purpose of this study was to evaluate role conflict between professional and familial responsibilities among obstetric health care providers during a natural disaster between those required to stay in the hospital versus those who were at home during a catastrophic weather event.

A survey was used of obstetric attending and resident physicians in the Baylor College of Medicine, Department of Obstetrics and Gynecology following Hurricane Harvey on August 26, 2017.

Ninety one of 103 physicians (88%) completed the survey. Survey responses were compared between physicians who worked in the hospital (n = 47) versus those who were at home (n = 44) during the storm and its immediate aftermath. Physicians in the hospital and at home agreed (47% and 48%, respectively, P = 0.94) that professional duties conflicted with family obligations and felt torn (49% and 55%, respectively, P = 0.48) regarding family obligations. A majority of homebound health care providers disagreed with the statement that professional duties override family responsibilities, whereas less than half of in-hospital providers felt the same (68% at-home versus 47% of the hospital-team, P = 0.10).

As organizations prepare for possible catastrophic situations, institutions must realize that obstetric health care providers will experience role conflict between professional and family responsibilities. (Disaster Med Public Health Preparedness. 2019;13:33–37)

The largest gas leak in United States history occurred October 2015 through February 2016 near Porter Ranch (PR), California, and prompted the temporary relocation of nearby residents because of health concerns related to natural gas exposure.

A retrospective cohort study was conducted using US Department of Veterans Affairs (VA) administrative and clinical data. On the basis of zip codes, we created two groups: PR (1920 patients) and San Fernando Valley (SFV) (15 260 patients) and examined the proportion of outpatient visits to VA providers with respiratory-related diagnoses between October 2014 and September 2017.

We observed an increase in the proportion of visits in the PR group during the leak (7.0% vs 6.1%, P<0.005) and immediately after the leak (7.7% vs 5.3%, P<0.0001). For both groups, we observed a decrease in respiratory diagnoses one year after the leak (7.0% to 5.9%, P<0.05 PR; 6.1% to 5.7%, P<0.01 SFV).

Exposure to natural gas likely led to the observed increase in respiratory-related diagnoses during and after the PR gas leak. Early relocation following natural gas leaks may mitigate respiratory exacerbations. (Disaster Med Public Health Preparedness. 2019;13:419-423)

This study seeks to determine the capacity of community primary care practices to meet the needs of patients during public health emergencies and to identify the barriers and resources necessary to participate in a coordinated response with public safety agencies.

The self-administered web-based survey was distributed in January 2014 via e-mail to primary care providers in Pennsylvania using the listservs of several professional societies.

A total of 179 primary care providers participated in the survey. In total, 38% had practice continuity of operations plan in place and 26% reported that they had a plan for patient surge in the outpatient setting. Thirty percent reported that they were registered on the state Health Alert Network and 41% said they were able to communicate with patients during disasters. Only 8% of providers reported that they believed that their patients with special health care needs were prepared for a disaster, although over two-thirds of responding practices felt they could assist these patients with disaster preparedness. Providers indicated that more information regarding government agency plans and community resources, patient education materials, and more time to devote to counseling during patient encounters would improve their ability to prepare their patients with special health care needs for disasters. Providers also reported that they would benefit from partnerships to help the practice during emergencies and communications technology to reach large numbers of patients quickly.

Community-based primary care practices can be useful partners during public health emergencies. Efforts to promote continuity of operations planning, improved coordination with government and community partners, as well as preparedness for patients with special health care needs, would augment their capabilities and contribute to community resilience. (Disaster Med Public Health Preparedness. 2019;13:128–132).

Communication is essential during public health emergencies and incidents. This research aimed to understand current uses and challenges for public health agencies using social media during these incidents.

An exploratory, qualitative study was conducted using the structured interview matrix facilitation technique. Focus groups were held with professionals from local public health agencies across Ontario, Canada. Representation from different geographic regions was sought to capture differences in participant experience. An inductive approach to content analysis was used to identify emergent themes.

A diverse group of public health professionals (n = 36) participated. Six themes were identified. Social media is identified as a communication tool used to expand reach of messages, to engage in dialogue with the public, and to inform the scope of potential incidents. Barriers to its use include hesitancy to adapt, lack of trust and credibility, and organizational structure and capacity constraints. Key strategies proposed to promote social media use and address barriers resulted from participant discussions and are presented.

Social media use is highly variable across public health agencies in Ontario. This study identifies and provides strategies to address barriers and practice gaps related to public health agencies’ use of social media during emergencies.