The Sydney City-2-Surf is the world’s largest annual run entered by around 80,000 people. First aid planning at mass participation running events such as the City-2-Surf is an area in the medical literature that has received little attention. Consequently, first aid planning for these events is based on experience rather than evidence. The models for predicting casualties that currently exist in the literature are either dated or not statistically significant.

The aim of this study was to characterize patterns of injuries linked to geographic location across the course of the City-2-Surf, and to explore relationships of injury types with location and meteorological conditions.

Records for formally treated casualties and meteorological conditions were obtained for the race years 2010-2016 and statistically analyzed to find associations between meteorological conditions, geographic conditions, casualty types, and location.

The most common casualties encountered were heat exhaustion or hyperthermia (39.2%), musculoskeletal (25.4%), and physical exhaustion (10.2%). Associations were found between gradient and the location. Type of casualty incidence with the individual distribution trends of casualty types were quite clear. Clusters of musculoskeletal casualties emerged in the parts of the course with the steepest negative gradients, while a cluster of cardiovascular events was found to occur at the top of the ‘heartbreak hill,’ the longest climb of the race. Regression analysis highlighted the linear relationship between the number of heat and physical exhaustion casualties and the apparent temperature (AT) at 12pm (R²= 0.59, P=0.044). This linear equation was used to formulate a model to predict these casualties.

The findings of this study demonstrate the relationship between meteorological conditions, geographic conditions, and casualties. This will assist planners of other similar events to determine optimum allocation of resources to anticipated injury and illness burden.

Obstacle Course Races (OCR) are mass participation sporting events, challenging participants to complete physical and mental tasks over a variety of distances and terrains. The case series studied, Spartan Race, has races occurring in urban, rural, and wilderness venues, ranging from 5 to 42 kilometers, while incorporating 20 to 60 obstacles.

To understand the injury rates, injury and illness patterns, and transport considerations within OCRs.

A secondary data analysis of de-identified medical charts from 56 Spartan Race events occurring in Eastern Canada from 2014 to 2018 was performed. The scope of practice was first aid from 2014 to 2017, with the addition of advanced life support onsite in 2018.

Over 5 years, 2,387 injuries occurred among 127,481 participants, creating a patient presentation rate of 18.7/1000. Although the majority of injuries (92%; n=2,204) were treated onsite, a transport to hospital rate of 1.2/1000 (n=154) occurred along with an ambulance transport rate of 0.23/1000 (n=29). Lacerations (55%) and musculoskeletal (36%) injuries were the most frequent clinical presentations observed, whereas life-threatening emergencies (affecting airway, breathing, and circulation) were infrequent (n=10). Transport to the closest local tertiary care center was on average 49.8 kilometers (25.3 kilometers) and 40.5 minutes (17.9 minutes) away from the venue.

These results suggest that there may be an upper limit to the injury rates within Spartan Races. The majority of patient presentations were able to be treated onsite, supporting the need for a qualified onsite medical team to mitigate the strain on local healthcare systems. Although life-threatening emergencies were uncommon, they do occur, and medical teams must be appropriately prepared. Further research is needed to understand the staffing and equipment requirements of medical teams, the demographic information of the injured, and the examination of the impact OCR events have on the local health care systems.

Roof-harvested rainwater held in domestic tanks is used for a variety of purposes in Australia, including drinking and irrigation. There is limited evidence about the quality of rainwater after bushfires. Current health guidelines can be interpreted that landholders need to drain their rainwater tanks to avoid the risk of contamination. Anecdotal reports indicate that following such advice caused additional distress to landowners affected by bushfires in South Australia. Sustainable water management is important for future resilience and more evidence on water quality following bushfires is needed.

This project investigated whether there is contamination of roof-harvested rainwater after bushfires, and if so, whether such water was safe for various purposes.

In 2017 we tested artificially contaminated water spiked with chemicals associated with bushfires (chromated copper arsenate-treated ash and firefighting foam) and conducted a pilot field study using two purposely built roofs during a pre-fire season burn off. A field validation is planned for the summer of 2018/19 (December 2018 - March 2019), i.e., we plan to obtain 200 samples from 50 households affected by bushfire – two samples immediately after the fire event and another two after the first rain.

The artificially created contaminated water fell within guidelines for non-potable uses such as irrigation and stock watering, but was found unsuitable for drinking even after being filtered through two commercially available water filtration systems. We also plan to present results from our field study of 50 households.

Contaminant concentrations, even in artificially spiked water samples, are low and acceptable for non-potable uses. Bottled water should be used for drinking. Landholders should be encouraged to use their water for recovery purposes. Such advice may assist with decreasing the stress experienced by affected landholders and help with recovery efforts through the availability of a greater body of water.

Children represent a particularly vulnerable population in disasters. Disaster Risk Reduction refers to a systematic approach to identifying, assessing, and reducing risks of disaster through sets of interventions towards disaster causes and population vulnerabilities. Disaster Risk Reduction through the education of the population, and especially children, is an emerging field requiring further study.

To test the hypothesis that an educational program on Disaster Risk Reduction can induce a sustained improvement in knowledge, risk perception, awareness, and attitudes toward preparedness behavior of children.

A Disaster Risk Reduction educational program for students aged 10-12 was completed in an earthquake-prone region of Jordan (Madaba). Subject students (A) and control groups of similarly aged untrained children in public (B) and private (C) schools were surveyed one year after the program. Surveys focused on disaster knowledge, risk perception, awareness, and preparedness behavior. Likert scales were used for some questions and binary yes/no for others. Results were collated and total scores averaged for each section. Average scores were compared between groups and analyzed using SPSS.

Students who had completed the Disaster Risk Reduction program were found through Levene’s test to have statistically significant improvement in earthquake knowledge (5.921 vs. 4.55 vs. 5.125), enhanced risk perception (3.966 vs. 3.580 vs. 3.789), and improved awareness of earthquakes (4.652 vs. 3.293 vs. 4.060) with heightened attitudes toward preparedness behavior (8.008 vs. 6.517 vs. 7.597) when compared to untrained public and private school control groups, respectively.

Disaster Risk Reduction education programs can have lasting impacts when applied to children. They can improve students’ knowledge, risk perception, awareness, and attitudes towards preparedness. Further work is required to determine the frequency of re-education required and appropriate age groups for educational interventions.

The Fort McMurray Alberta wildfire was one of Canada’s largest natural disasters in history, burning 589,995 hectares of land until being controlled on July 5, 2016. In responding to the fire, Alberta Health Services (AHS) prompted a province-wide coordinated response. Through a combination of pre-emptive strategies and responsive activities, the AHS response has been considered a success. Underlying the successful response is the collective experiences and contextual knowledge of AHS staff members acquired from past events. While the frequency and severity of risks associated with extreme weather and climate change are increasing worldwide, there is a persistent knowledge gap in the evidence-base informing public health emergency preparedness. It is imperative that lessons learned from past events inform future preparedness activities. Learning lessons is a systematic implementation process that can be used to inform future responses and best practices that are transferable to similar situations.

To describe strategies employed and challenges encountered during recovery after the Alberta wildfires.

A single-case study approach was employed to understand the AHS method to “learning lessons,” and the process involved in translating lessons into actionable goals. Semi-structured interviews with senior leaders (n=11) were conducted and internal documents were obtained.

The analysis revealed a strategic learning process, including debriefs, staff surveys, interviews, and member validity checking. The implementation process used to translate the lessons identified included a project management framework, evaluation techniques, and the utilization of tacit and explicit knowledge. Key challenges for implementation involve clarification of processes, leadership commitment, resource and time constraints, staff turn-over, and measuring outcomes.

Translating the lessons from the Alberta wildfires is crucial for enhancing preparedness, and exploratory research in this area can contribute to building a program of research in evaluation during disaster recovery.

In August 2018, Kerala, India witnessed its worst flood in over a century. With the support of the national health mission, Operation Navajeevan, a public-private partnership between the district health administration and local hospitals was established in Kozhikode to provide medical aid to flood victims. This study identifies prerequisites, describes challenges, and depicts the epidemiology of patients seen in these camps.

1. 1. Identify prerequisites and medical needs/challenges faced by medical relief camps in a flood-affected region

2. 2. Formulate protocols to avoid duplication of services

3. 3. Prepare an ideal PPP emergency medical camp model

A control center with drugs and a logistics unit was set up at the district administration to monitor and supervise various camps. A mobile medical documentation format was created to record the details of each camp. Cases of patients seen at these camps were compiled and later analyzed. The medical officer sent reports from each camp to the control center each day to specify the daily difficulties faced by each camp. Mobile ICUs were kept on standby to respond in the event of emergent circumstances or surge demands. Transfer protocol and treatment guidelines were formulated and standardized.

Over two weeks, approximately 40,000 patients were seen in 280 medical camps. Major medical issues included exacerbation of chronic illnesses due to loss of medications (18,490), acute respiratory infections (7,451), psychiatric illnesses (5,327), trauma (3,736), skin infection (792), tropical fever (498), acute gastroenteritis (394), and ACS (17). Of the cases of fever, 137 people had leptospirosis. Major challenges included a lack of training in disaster management and failure of documentation systems.

A well-organized control center, improved training in disaster medicine, and reliable documentation systems are crucial for coordinating medical camps in disaster areas. Public-private partnerships offer a model for providing medical relief in disaster settings.

For recent years, we often hear the words, “never experienced before” on a weather forecast in Japan.

To evaluate our response to “Heisei 30-year July heavy rain” in the Hyogo Emergency Medical Operations Center.

Review our actions taken and exchanges of views with local government representatives in a time-related manner compared with public announcements of evacuation/sheltering warning.

A specialized warning of heavy rain was announced at 10:50 PM on Friday by the local meteorological observatory. At 11:50 PM, the emergency management headquarters of prefectural medical response was established in the hospital, but a connection could not be established to 10 regional health centers for the weekend. Water levels of some rivers were increasing nearly to flood levels, and an evacuation order was announced to hundreds of thousands of people. This situation continued for a few days throughout many regions. The information of flood or landslide probability was continuously monitored, but an attempt was made to decide the timing of cancellations of standby.

An ordinary response to disaster depends on a clear turning point, such as the occurrence time. In heavy rainfall, there are two issues. One is about actions to prevent disaster and another is a recognition of geographic points or surface. Many critiques to the response focus on the judgments and actions for prevention before a critical event. Lessons learned included the importance of preventive actions along with a timeline and the judgment of restoration.

An inland earthquake is expected to occur in Tokyo in the near future, and disaster preparedness and response measures have been put in place by the government of Japan and local authorities.

Japan Disaster Medical Assistant Teams (DMATs) conducted two large-scale drills for the first time in preparation for a Tokyo inland earthquake, in collaboration with the following participants: the Tokyo Metropolitan Government, disaster base hospitals in Tokyo, three Staging Care Units (SCUs), and neighboring prefectures. One of the scenarios was a north Tokyo Bay earthquake affecting the Tokyo wards and had 142 Japan DMATs participation. Another scenario was Tama inland earthquake affected mid-west of Tokyo and 110 DMATs participated. The drill included headquarters operation, affected hospital support operation, patient transportation within the area and to the wider region, SCU operation, collaboration with associated organizations, and logistics operation.

Post-drill assessments identified the following areas that need to be addressed: review of Japan DMAT implementation strategies; improvement of SCUs; establishment of a patient air transportation framework; securing means of patient transportation; improvement of communication systems; strengthening of disaster response of all hospitals in the Tokyo Metropolis; and preparations for survival in the event of isolation caused by the disaster.

The Nankai Trough, marking the boundary between the Eurasian Plate and the Philippine Sea Plate, is forecasted to create a tragic earthquake and tsunami within 30 years.

To clarify the gap between medical supplies and demand.

Collected the data of the estimation of injured persons from each prefecture throughout Japan, and also the number of Intensive Care Unit (ICU) and High Care Unit (HCU) beds in Japan from the Ministry of Health database. We re-calculated the number of severe cases based on official data. Moreover, we calculated the number of beds of hospitals with the capacity to receive severe patients.

The total number of disaster base hospitals is 723 hospitals with 6556 ICU beds, and 545 hospitals have 5,248 HCU beds throughout Japan. When the Nankai Trough earthquake occurs, 187 disaster base hospitals would be located in the area with seismic intensity 6-upper on the Japanese Seismic Intensity Scale of 0-7, and 79 disaster base hospitals would be located in the tsunami inundation area. The estimated total number of injured persons is 661,604 including 26,857 severe cases, 290,065 moderate cases, and 344,682 minor cases.

Even if all ICU and HCU beds are usable for severe patients, there will be 15,053 more beds needed. The Cabinet Office of Japan assumes that 60% of hospital beds would not be able to be used in an area of the seismic intensity of 6-upper. If 80% of beds are used in the non-disaster time, the number of beds which are usable at the time of a disaster will decrease more. The beds needed for severe patients would be significantly lacking when the Nankai Trough earthquake occurs. It will be necessary to start treatment of the severe patients who are “more likely to be saved more.”

After Hurricane Harvey and the flooding that ensued, 3,829 displaced persons were transported from their homes and sheltered in the Dallas Convention Center. This large general population sheltering operation was medically supported by the onsite Mega-Shelter Medical Clinic (MMC). In an altered standard of care environment, a number of multi-disciplinary medical services were provided including emergent management, acute pediatric and adult care, psychiatric/behavioral services, onsite pharmaceutical, and durable medical equipment distribution, epidemiologic surveillance, and select laboratory services.

To describe how onsite medical care in the adapted environment of a large population shelter can provide comparable services and limit the direct impact on the local medical community.

A retrospective chart review of medical records was generated for all clinical encounters at the MMC. Data were sorted by daily census, disease surveillance, medical decision making, treatment, and transport destinations.

40.7% of registered evacuees utilized the MMC accounting for a total of 2,654 clinic visits by 1,560 unique patients representing all age groups. During the sustained MMC operations, 8% of patients required emergency transport and 500 additional patient transports were arranged for clinic appointments. No deaths occurred and no iatrogenic morbidity was reported.

Medical care was provided for a large number of evacuees which mitigated the potential impact on the local medical infrastructure. The provision of medical services in a large population shelter may necessitate adaptation to the standard of care. However, despite the nontraditional clinical setting, care delivery was not compromised.

As a subtropical urbanized city in Southeast Asia, Hong Kong is prone to frequent typhoons. With an increasing number of severe typhoons, usual preparedness measures should be explored to assess their adequacy to safeguard health and wellbeing. Typhoon Mangkhut (2018) serves as an example of the successes and limitations of community preparedness for a severe typhoon.

To explore how Hong Kong residents prepared for Typhoon Mangkhut and whether their usual preparedness measures provided enough protection.

A population-based randomized telephone survey of Hong Kong residents (n=521) was conducted soon after Typhoon Mangkhut’s landing. Only residents aged 18 or above and understood Cantonese were included. Socio-demographic factors, types of typhoon and general preparedness, risk perception, and impacts from the typhoon were asked. Descriptive characteristics and univariate analysis were used to describe the patterns and associations.

8.6% of respondents felt their home was at high risk of danger during typhoons although 33.4% reported some form of impact from Mangkhut. Over 70% reported doing at least one typhoon specific preparedness measure. Among those who practiced at least one typhoon specific preparedness measure, 37.2% (p=0.002) were affected by the typhoon.

Despite the high adaptation of preparedness measures, warranted by the frequent typhoons, Hong Kong residents were not adequately prepared for a severe typhoon. While the early warning system and evacuation of flood-prone areas mitigated some of the impact, unexpected effects such as flying air conditioners, roadblocks affecting employment, swaying buildings, and loss of power supply were not accounted for. Future preparedness for natural disasters which will become more extreme due to climate change and needs to account for unforeseen risks.

Climate change has brought more extreme weather events to Hong Kong. The increasing number of powerful tropical cyclones that hammered Hong Kong in recent years reminded the territory to review typhoon preparedness of the community.

Typhoon Mangkhut slammed Hong Kong in September 2018 and caused significant devastation. Three weeks after the devastation, the Hong Kong Jockey Club Disaster Preparedness and Response Institute commissioned the Public Opinion Programme at The University of Hong Kong to conduct a survey to understand the general Hong Kong public’s typhoon preparedness measures and their information seeking behaviors.

A cross-sectional population-based anonymous telephone survey was conducted on a random sample of 1,018 Cantonese-speaking adults aged 18 or above.

The most common typhoon preparedness measures were taping windows (45%), followed by food stockpiling (18%), and closing of doors/windows (10%). Only 2% and 1% of the respondents were prepared for water and power outage, respectively. 36% of the respondents did not take any precautionary measures. 29% sought typhoon precautionary measures information from the mass media and 31% of respondents relied on their previous experience. Other sources of information included government sources (7%) and social media (7%).

Though no death cases were reported related to Typhoon Mangkhut, the effect of the superstorm caused over 300 casualties, blocked roads, and transportation chaos caused by fallen trees and other debris, power and water outage, serious floods, and severely damaged public and private facilities. Around 40,000 households experienced a power outage and some residential estates were left without water. The survey revealed the lack of precautionary measures of the Hong Kong public for power and water outage. More education on typhoon preparedness, especially on power and water outage and more community-level support on localized disaster preparedness advice, would likely improve disaster preparedness for the Hong Kong public.

Disasters can damage the essential public health infrastructure and social protection systems required for vulnerable populations. This contributes to indirect mortality and morbidity as high as 70–90%, primarily due to an exacerbation of life-threatening conditions and chronic diseases. Despite this, the traditional focus of public health systems has been on communicable diseases. To address this challenge, disaster and health planners require access to repeatable and measurable methods to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.

Propose a repeatable and measurable method for ranking and prioritizing the needs of people with life-threatening and chronic diseases before, during, and after a disaster.

The research began with identifying the risk disasters pose to people with life-threatening and chronic diseases. The data gathered was then used to develop indicators and explore the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize the needs before, during, and after a disaster.

This research found people at greatest risk are those with underlying cardiovascular and respiratory diseases, unstable diabetes, renal diseases, and those undergoing cancer treatment. A sustainable method to help address this problem is to expand the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize needs at national and sub-national levels.

DisasterAWARE™ has been successfully applied to the assessment and prioritization of disaster risk and humanitarian assistance needs in Southeast Asia (ASEAN, Viet Nam), Central America (Guatemala, El Salvador, Honduras, Nicaragua), South America (Peru), and the Caribbean (Jamaica, Dominican Republic). Using the indicators developed through this research, this proven methodology can be seamlessly and easily translated to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.

Natural disasters often damage the public health infrastructure required to maintain the wellbeing of people with noncommunicable diseases. This increases the risk of an acute exacerbation or complications, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of noncommunicable diseases will continue, if not increase, due to an increasing disease prevalence, sustained rise in the frequency and intensity of disasters, and rapid unsustainable urbanization in disaster-prone areas. However, the traditional focus of public health and disaster systems remains on communicable diseases, despite a low risk. There is now an urgent need to expand the public health response to include noncommunicable diseases.

To explore the key influences on patient ability to successfully manage their noncommunicable disease after a natural disaster.

A survey of people with noncommunicable diseases in Queensland, Australia, collected data on demographics, disease/condition, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with Bonferroni-adjustment were used to analyze data.

There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatigue and shortness of breath were common concerns for all noncommunicable diseases. Those dependent on care from others were most worried about shortness of breath and slow healing sores. Accessing medication and medical services were priorities for all patients post-disaster.

The key influences on successful self-management post disaster for people with noncommunicable diseases must be reflected in disaster plans and strategies. Achieving this will reduce exacerbations or complications of disease and decrease demand for emergency health care post-disaster.

The Sendai Framework seeks to substantially reduce disaster risk and losses in lives, livelihoods, health, and other assets including persons, communities, and countries. The framework focuses on reducing mortality while increasing population wellbeing, early warning, and promotion of health systems resilience. The use of scientific evidence to inform policy and formulate effective initiatives and interventions is crucial to disaster risk reduction within health. Different instruments and methodologies are available to guide policy and operations. The potential value of routinely collected patient data from health registers is that they can provide pre-event health and comparison group data without burdening affected populations.

The current contribution aims to illustrate how health registers can help monitor the health impact of natural and human-made disasters.

Patient data from health registers of general practitioners and other health professionals, sometimes combined with other registers and data sources, have been utilized to monitor the health impact of disasters and environmental hazards in the Netherlands, Norway, and Sweden since 2000.

Health registers allowed monitoring of mental health problems, medically unexplained symptoms, chronic health problems, and social problems. These were compared to groups not directly exposed. The health impact and care utilization was tracked after the fireworks explosion in Enschede affecting inhabitants of the neighborhood (2000; data range 1999-2005), children and parents after the Volendam café fire (2001; data range 2000-2006), Swedish survivors of the Tsunami in Southeast Asia (2004; data range 2004-2010), and parents of children affected by the terrorist attack on Utøya (2011; data range 2008-2014).

Health systems with registers have an important advantage when it comes to the potential for monitoring population health, and perhaps offer early warnings of pandemics. However, data generation should be closely connected to policy-making before and during the planning and evaluation of public health intervention.

As the incidence of cancer and the frequency of extreme weather events rise, disaster mitigation is becoming increasingly relevant to oncology care.

To investigate the effect of natural disasters on cancer care and the associated health effects on patients with cancer through the means of a systematic review.

Between database inception and November 12, 2016, Embase, ScienceDirect, MEDLINE, Scopus, PsycINFO, Web of Science, and CINAHL were searched for articles. Those identifying the effect of natural disasters on oncology services, or the associated health implications for patients with cancer, were included. Only articles published in English were included. Data extraction was done by two authors independently and then verified by all authors. The effects of disaster events on oncology services, survival outcomes, and psychological issues were assessed.

Natural disasters cause substantial interruption to the provision of oncology care. Of the 4,593 studies identified, only 85 articles met all the eligibility criteria. Damage to infrastructure, communication systems, medication, and medical record losses substantially disrupt oncology care. The effect of extreme weather events on survival outcomes is limited to only a small number of studies, often with inadequate follow-up periods.

To the best the authors’ knowledge, this is the first systematic review to assess the existing evidence base on the health effects of natural disaster events on cancer care. Disaster planning must begin to take into consideration patients with cancer.

On June 23 and 24, 2016, a heavy hailstorm in the south of the Netherlands destroyed farms, greenhouses, and crops, and caused severe damage to many residences and cars in multiple communities. The size of the massive hailstones ranged from 3 to 5 centimeters in diameter. The farm damages alone were estimated to be 100 million euros, while total insurance industry losses were expected to exceed half a billion euros. In addition to the storm, the affected region also had its first tropical day of the year, with temperatures reaching 32 degrees Celsius. To date, the psychosocial impact and possible adverse health effects caused by the storm have not been thoroughly investigated.

To explore whether the occurrence of chronic and acute health problems in the affected region increased after the hailstorm compared to “control” areas.

Health data for the time period before (2013-2015) and immediately after the hailstorm (2016-2018) will be collected based on electronic health records (morbidity, psychosocial problems, and prescribed medication) from general practices (GP) located in the affected municipalities. For the same period, health problems in the affected region will also be compared with GP-registered data from different Dutch municipalities with similar urbanization levels, which will be used as a control group. The combination with external datasets (e.g. socioeconomic status, environmental exposures) will also be considered.

Multilevel regression analyses will be carried out to test the health impact of this sudden, onset event. The current study is a work in progress. Final results are expected in February 2019 and are presented during the conference.

The present study illustrates how routinely collected patient health records, recorded by GPs, can be used for epidemiological research in the aftermath of a disaster within the context of climate and weather extremes in Europe.

Public health emergency management involves the timely translation of relevant evidence and effective coordination of diverse actors. In practice, this can be challenging in the absence of a common framework for action among diverse actors.

To apply an Integrated Knowledge Translation (iKT) approach throughout the development of a conceptual framework and performance measurement indicators for public health emergency preparedness (PHEP), to ensure knowledge generated is relevant and useful to the field.

The iKT approach was initiated by identifying a research question based on priorities from the field. The two phases of the study used participatory research methods as well as active engagement with potential end users at key study milestones. The Structured Interview Matrix (SIM) facilitation technique for focus groups and an expert panel using Delphi methodology were used to define the PHEP framework and performance measurement indicators, respectively. An advisory committee was assembled consisting of potential end-users of the research, in senior positions in applied and decision-making roles.

iKT was an essential component for this applied public health project, contributing to and enhancing the relevance of the knowledge generated. iKT contributed to the following: broad national engagement and interest in the study, successful recruitment in both phases, and engagement with decision-makers. This multi-dimensional participatory approach successfully generated knowledge that was important to the field demonstrated by relevance to practice and policy in jurisdictions across Canada. Furthermore, the approach fostered building resilience in local and national communities through collaboration.

The iKT approach was essential to generating knowledge that is relevant and useful to the field, mainly to promote health system preparedness and resilience. Future research to study the implementation of knowledge will be important to continue addressing the knowledge-to-action gap in health emergency management research.

In the United States, tornadoes are the third leading cause of fatalities from natural disasters1. To aid prevention and mitigation of tornado-related morbidity and mortality, improvement in standardizing tornado specific threat analysis terminology was assessed. The largest number of tornado-related fatalities has occurred in the state of Texas for over a hundred years. The occurrence of tornadic clusters or “outbreaks” has not been formally standardized. The concept of “tornado outbreaks” is better defined and its role in fatality mitigation is addressed in this Institutional Review Board (IRB) approved study.

To understand the role of “tornado outbreaks” related clusters in Texas in relationship to morbidity and mortality.

This IRB approved (IRB2017- 0507) research study utilized GIS tools and statistical analysis of historical data to examine the relationship between tornado severity (based on the Fujita Scale), the number of tornadoes, and the trends in morbidity and mortality. This study was funded in part from The National Science Foundation grant (NSF Grant #1560106) in support of the CyberHealthGIS Research Experience for Undergraduates (REU).

A statistically significant difference was demonstrated between the severity of a tornado and related morbidity and mortality during “tornado outbreaks” in Texas during a defined 30-year period.

Understanding the role and discerning the impacts of “tornado outbreaks” as related to tornado severity has critical implications to disaster preparedness. Applications of this conclusion may improve shelter planning/preparation, timely warning, and educating the at-risk public. Subsequently, examining the likelihood and improved descriptions of “tornado outbreaks” may aid in reducing the number of tornado-related injuries and fatalities nationally.

Nurses’ broad knowledge and treatment skills are instrumental to disaster management. Roles, responsibilities, and practice take on additional dimensions to their regular roles during these times. Despite this crucial position, the literature indicates a gap between their actual work in emergencies and the investment in training and establishing response plans.

To explore trends in disaster nursing reflected in professional literature, link these trends to current disaster nursing competencies and standards, and reflect based on the literature how nursing can better contribute to disaster management.

A systematic literature review, conducted using six electronic databases, and examination of peer-reviewed English journal articles. Selected publications were examined to explore the domains of disaster nursing: policy, education, practice, research. Additional considerations were the scope of the paper: local, national, regional, or international. The International Nursing Councils’ (ICN) Disaster-Nursing competencies are examined in this context.

The search yielded 171 articles that met the inclusion criteria. Articles were published between 2001 and 2018, showing an annual increase. Of the articles, 48% (n = 82) were research studies and 12% (n = 20) were defined as dealing with management issues. Classified by domain, 48% (n = 82) dealt with practical implications of disaster nursing and 35% (n = 60) discussed educational issues. Only 11% of the papers reviewed policy matters, and of these, two included research. Classified by scope, about 11% (n =18) had an international perspective.

Current standards attribute a greater role to disaster-nursing in leadership in disaster preparedness, particularly from a policy perspective. However, this study indicates that only about 11% of publications reviewed policy issues and management matters. A high percentage of educational publications discuss the importance of including disaster nursing issues in the curricula. In order to advance this area, there is a need to conduct dedicated studies.