Heavy rain and flash flooding left behind a trail of disaster in the western and south-western provinces of Iran in April 2016. The purpose of this study is to highlight the response functions that should be undertaken when such disasters strike.

Secondary data, such as documents, organizational reports, and forms completed during response to the flood visits, were the methods of data collection in this study. Then, collected data were analyzed according to the response functions to disasters.

The study found that a strong disaster response function was the early warning system, by the Iran Meteorological Organization, announced 1 week before the flood. Weaker functions were the lack of coordination among response organizations and the lack of a safety officer in the Incident Command System structure during the flash flood.

The list of the disaster response functions identified by this study should aid the decision makers and first responders in facing natural or man-made disasters and enable them to better prepare for response functions in the future disasters.

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.

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.

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.

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.

Access to primary health care (PHC) is very important for refugees. The aim of this study was to illuminate lived experience of Afghan refugees in Iran regarding PHC delivery.

This qualitative study was conducted in 2016–2017 by using the content analysis technique. Data were collected through individual deep interviews with Afghan refugees who lived in Iran. The data were analyzed by using a method by Graneheim and Lundman.

Four main categories and 12 subcategories were emerged, including (1) challenges before PHC delivery: large number of children, high service cost, not having medical insurance, access to health centers, appointment to get services, simultaneity of breastfeeding, and pregnancy; (2) challenges during PHC delivery: understanding Iranian words, health care provider’s behavior, delay in getting service in PHC centers; (3) challenges after delivery PHC: referral patient, high costs of paraclinics; and (4) free and good services.

Our results showed that Afghan refugees have several challenges in every stage of PHC delivery. Awareness of such problems can help medical personnel improve delivery of service to Afghan refugees, as well as using trained Afghani nurses to serve the refugees.

In 2010, South Africa (SA) hosted the Fédération Internationale de Football Association (FIFA) World Cup (soccer). Emergency Medical Services (EMS) used the SA mass gathering medicine (MGM) resource model to predict resource allocation. This study analyzed data from the World Cup and compared them with the resource allocation predicted by the SA mass gathering model.

Prospectively, data were collected from patient contacts at 9 venues across the Western Cape province of South Africa. Required resources were based on the number of patients seeking basic life support (BLS), intermediate life support (ILS), and advanced life support (ALS). Overall patient presentation rates (PPRs) and transport to hospital rates (TTHRs) were also calculated.

BLS services were required for 78.4% (n = 1279) of patients and were consistently overestimated using the SA mass gathering model. ILS services were required for 14.0% (n = 228), and ALS services were required for 3.1% (n = 51) of patients. Both ILS and ALS services, and TTHR were underestimated at smaller venues.

The MGM predictive model overestimated BLS requirements and inconsistently predicted ILS and ALS requirements. MGM resource models, which are heavily based on predicted attendance levels, have inherent limitations, which may be improved by using research-based outcomes.

To assess the psychological impact of a mass casualty incident (MCI) in a subset of personnel in a level I hospital.

Emergency department staff responded to an MCI in June 2017 in Turin, Italy by an unexpected sudden surge of casualties following a stampede (mass escape). Participants completed the Psychological Simple Triage and Rapid Treatment Responder Self-Triage System (PsySTART-R), which classified the potential risk of psychological distress in “no risk” versus “at risk” categorization and identified a range of impacts aggregated for the population of medical responders. Participants were administered a questionnaire on the perceived effectiveness of management of the MCI. Two months later, the participants were evaluated using the Hospital Anxiety and Depression Scale (HADS), the Kessler Psychological Distress Scale (K6), and the Posttraumatic Stress Disorder Checklist (PCL-5).

The majority of the responders were classified as “no risk” by the PsySTART-R; no significant differences on HADS, K6, and PCL-5 were found in the participants grouped by the PsySTART-R categories. The personnel acquainted to work in emergency contexts (emergency department and intensive care unit) scored significantly lower in the HADS than the personnel usually working in other wards. The number of positive PsySTART-R criteria correlated with the HADS depression score.

Most of the adverse psychological implications of the MCI were well handled and averted by the responders. A possible explanation could be related to factors such as the clinical condition of the victims (most were not severely injured, no fatalities), the small number of casualties (87) brought to the hospital, the event not being considered life-threatening, and its brief duration, among others. Responders had mainly to cope with a sudden surge in casualties and with organizational issues.

The aim of this study was to (1) assess the long-term mental and behavioral health outcomes of the Deepwater Horizon Oil Spill of residents in the Gulf Coast and to (2) identify populations that may be particularly vulnerable to future disasters.

The Survey of Trauma, Resilience, and Opportunity in Neighborhoods in the Gulf (STRONG) is a population-representative sample of 2520 coastal residents surveyed in Texas, Louisiana, Alabama, Mississippi, and Florida in 2016. We present prevalence estimates for positive screens of depression, anxiety, and alcohol misuse, as well as receipt of health care services. We examine differences in these outcomes across states, affected occupational groups, and demographic groups.

Resource loss attributed to the spill was associated with positive screens for depression and anxiety. Almost 50% of adults screened positive for depression, anxiety, or alcohol misuse, but less than 20% of these currently access mental health care. Black residents were less likely to have health insurance and a usual source of care but were more likely to have visited the emergency room in the past 12 months.

Surveillance data from STRONG can help policy-makers and other stakeholders develop targeted approaches to foster resilience, particularly among vulnerable populations, and thereby mitigate the effects of future disasters.

There has been little research on the health consequences of evacuation in the disaster context. A comparative analysis of survival between evacuated and nonevacuated hospital dialysis patients was conducted following Japan’s Fukushima Dai-ichi nuclear power plant incident, which occurred on March 11, 2011.

The study included 554 patients (mean age: 70.9) receiving dialysis therapy at one of the Tokiwakai Group hospitals—all of which are located in and around Iwaki City, approximately 50 km from the Fukushima nuclear plant—as of the incident date. The patients’ survival after the incident was tracked until March 3, 2017. Significant differences in mortality rates between postincident evacuees and nonevacuees were tested using the Bayesian survival analysis with Weibull multivariate regression.

Out of 554 dialysis patients, 418 (75.5%) were evacuated after the incident. The postincident mortality rate (adjusted for covariates) of evacuees was not statistically significantly different from that of nonevacuees. The hazard ratio was 1.17 (95% credible intervals: 0.77-1.74).

If performed in a well-planned manner with satisfactory arrangements for appropriate selection of evacuees and their transportation, evacuation could be a reasonable option, which might save more lives of vulnerable people.

We aimed to investigate the association between types of housing and allergic symptoms at 3–4 years following the Great East Japan Earthquake.

Our study was based on the ToMMo Child Health Study conducted in 2014 and 2015, a cross-sectional survey of public school children in Miyagi Prefecture, Japan. Of the 46 648 invited schoolchildren in the 2nd to 8th grades, 9884 were included. Presence of eczema, wheezing, and mental health symptoms was defined with questionnaires. To calculate odds ratios (ORs) and 95% CIs for the associations between types of housing and eczema or respiratory symptoms, we fitted generalized linear mixed models, included a random effect for municipality of residence, and adjusted for sex, school grade, survey year, and mental health symptoms.

Prefabricated temporary housing was significantly associated with eczema symptoms (OR, 1.46; 95% CI, 1.06–2.02). Even after adjusting for the presence of mental health symptoms, our analysis produced similar results (OR, 1.42; 95% CI, 1.03–1.96). Conversely, it was not significantly associated with respiratory symptoms (OR, 0.97; 95% CI, 0.61–1.54).

Children living in prefabricated temporary housing had a higher prevalence of eczema symptoms; however, prevalence of respiratory symptoms was not significantly higher.

Disaster-related research funding in the United States has not been described. This study characterizes Federal funding for disaster-related research for 5 professional disciplines: medicine, public health, social science, engineering, emergency management.

An online key word search was performed using the website, www.USAspending.gov, to identify federal awards, grants, and contracts during 2011–2016. A panel of experts then reviewed each entry for inclusion.

The search identified 9145 entries, of which 262 (3%) met inclusion criteria. Over 6 years, the Federal Government awarded US $69 325 130 for all disaster-related research. Total funding levels quadrupled in the first 3 years and then halved in the last 3 years. Half of the funding was for engineering, 3 times higher than social sciences and emergency management and 5 times higher than public health and medicine. Ten (11%) institutions received 52% of all funding. The search returned entries for only 12 of the 35 pre-identified disaster-related capabilities; 6 of 12 capabilities appear to have received no funding for at least 2 years.

US federal funding for disaster-related research is limited and highly variable during 2011–2016. There are no clear reasons for apportionment. There appears to be an absence of prioritization. There does not appear to be a strategy for alignment of research with national disaster policies.

The objective of this study is to characterize US-based disaster training courses available to disaster response and disaster health professionals. Its purpose is to better inform policies and decision-making regarding workforce and professional development to improve performance.

Courses were identified from 4 inventories of courses: (1) National Library of Medicine Disaster Lit database; (2) TRAIN National Learning Network; (3) Federal Emergency Management Agency (FEMA) National Preparedness Course Catalog; and (4) Preparedness and Emergency Response Learning Centers. An online search used 30 disaster-related key words. Data included the course title, description, target audience, and delivery modality. Levels of learning, target capability, and function were categorized by 3 expert reviewers. Descriptive statistics were used.

There were 3662 trainings: 2380 (65%) for professionals (53% for public health); 83% of the courses were distance learning, with 16% via classroom. Half of all trainings focused on 3 of 37 disaster capabilities and 38% of them were related to chemical, biological, radiological, nuclear, and explosives (CBRNE). The educational approach was knowledge-based for all courses and 99.6% imparted only lower levels of learning.

Despite thousands of courses available, there remain significant gaps in target audience, subject matter content, educational approaches, and delivery modalities, particularly for health and public health professionals.

To investigate the social and living conditions of households in Haiti before and after the 2010 earthquake and to determine the prevalence of emotional and physical abuse of children aged 2 to 14 in households after the earthquake.

Nationally representative samples of Haitian households from the 2005/2006 and 2012 phases of the Demographic and Health Surveys were used. Descriptive data were summarized with frequencies and measures of central tendency. Chi-squared and independent t tests were used to compare pre-earthquake and post-earthquake data. Basic mapping was used to explore patterns of child abuse in relation to proximity to the epicenter.

Comparison of pre-earthquake and post-earthquake data showed noteworthy improvements in the education attainment of the household head and possession of mobile phones after the earthquake. The prevalence of emotional, physical, and severe physical abuse in 2012 was estimated to be 78.5%, 77.0%, and 15.4%, respectively. Mapping revealed no conclusive patterns between the proximity of each region to the epicenter and the prevalence of the different forms of abuse. However, the prevalence of severe physical abuse was notably higher in settlement camps (25.0%) than it was in Haiti overall (15.4%).

The high prevalence of child abuse in Haiti highlights an urgent need for interventions aimed at reducing occurrences of household child abuse.

The Society of Academic Emergency Medicine Disaster Medicine Interest Group, the Office of the Assistant Secretary for Preparedness and Response – Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) team, and the National Institutes of Health Library searched disaster medicine peer-reviewed and gray literature to identify, review, and disseminate the most important new research in this field for academics and practitioners.

MEDLINE/PubMed and Scopus databases were searched with key words. Additional gray literature and focused hand search were performed. A Level I review of titles and abstracts with inclusion criteria of disaster medicine, health care system, and disaster type concepts was performed. Eight reviewers performed Level II full-text review and formal scoring for overall quality, impact, clarity, and importance, with scoring ranging from 0 to 20. Reviewers summarized and critiqued articles scoring 16.5 and above.

Articles totaling 1176 were identified, and 347 were screened in a Level II review. Of these, 193 (56%) were Original Research, 117 (34%) Case Report or other, and 37 (11%) were Review/Meta-Analysis. The average final score after a Level II review was 11.34. Eighteen articles scored 16.5 or higher. Of the 18 articles, 9 (50%) were Case Report or other, 7 (39%) were Original Research, and 2 (11%) were Review/Meta-Analysis.

This first review highlighted the breadth of disaster medicine, including emerging infectious disease outbreaks, terror attacks, and natural disasters. We hope this review becomes an annual source of actionable, pertinent literature for the emerging field of disaster medicine.

The objective of this study was to conduct comprehensive analyses of disaster patterns for Germany and France from a pediatric perspective.

An analysis of the Emergency Events Database (EM-DAT), epidemiological database with standard methods of descriptive and comparative statistics respecting the strengthening the reporting of observational studies in epidemiology (STROBE) criteria, was performed.

Between 2006 and 2016, there were 41 and 42 disasters in Germany and France claiming 259 and 4973 lives, respectively. Ages of afflicted individuals were not specified in EM-DAT. In Germany, most events were storms (37%), extreme temperatures (17%), floods (17%), and transport accidents (17%). In France, most events were storms (45%), extreme temperatures (17%), floods (19%), and transport accidents (14%). In Germany, most lives (96) were lost in transport accidents. In France, most casualties were due to the heat waves of 2006 and 2015 (1388 and 3275). Reported event types in Germany and France were similar, but heat waves struck France more significantly than Germany.

Pediatric data are not explicitly captured in EM-DAT, but reported disaster patterns suggest that exposures to heat and cold, storms, trauma, chemicals, water, and infectious agents are possible mechanisms of injury. Age-stratified disaster data are needed to enable a timely, transparent, coordinated, and sustained data-driven approach to pediatric disaster resilience.