Objective: Describe commercially available products and services designed to convey personal health information in emergencies.

Methods: The search engine Google®, supplemented by print ads, was used to identify companies and organizations that offer relevant products and services to the general market. Disease-specific, health system, and health plan-specific offerings were excluded. Vendor web sites were the primary sources of information, supplemented by telephone and e-mail queries to sales representatives. Perfect inter-rater agreement was achieved.

Results: Thirty-nine unique vendors were identified. Eight sell engraved jewelry. Three offer an embossed card or pamphlet. Twelve supply USB drives with various features. Eleven support password-protected web sites. Five maintain national call centers. Available media differed markedly with respect to capacity and accessibility. Quoted prices ranged from a one-time expenditure of $3.50 to an annual fee of $200. Associated features and annual fees varied widely.

Conclusion: A wide range of products and services exist to help patients convey personal health information. Health care providers should be familiar with their features, so they can access the information in a disaster or emergency.

(Disaster Med Public Health Preparedness. 2011;5:261–265)

An influenza pandemic can overwhelm the capacities of hospitals, clinics, nursing facilities, and emergency services. The likelihood is that most of the individuals who are stricken will be cared for at home, and there is strong evidence that in-home caregivers bear a disproportionate risk of becoming infected. We reviewed the scientific literature after 2000 to identify steps that in-home caregivers can take to reduce the chances that they and other household members will become infected in the home. Personal hygiene, common masks, and technologies including air filters and UV light each offer incremental benefits, and in combination are expected to reduce a portion of the risk that household members face when caring for a member who has become infected. In pandemics and even seasonal epidemics, seemingly small steps can literally mean the difference between life and death, especially for in-home caregivers.

(Disaster Med Public Health Preparedness. 2011;5:266–271)

Objectives: The November 26-29, 2008, terrorist attacks on Mumbai were unique in its international media attention, multiple strategies of attack, and the disproportionate national fear they triggered. Everyone was a target: random members of the general population, iconic targets, and foreigners alike were under attack by the terrorists.

Methods: A retrospective, descriptive study of the distribution of terror victims to various city hospitals, critical radius, surge capacity, and the nature of specialized medical interventions was gathered through police, legal reports, and interviews with key informants.

Results: Among the 172 killed and 304 injured people, about four-fifths were men (average age, 33 years) and 12% were foreign nationals. The case-fatality ratio for this event was 2.75:1, and the mortality rate among those who were critically injured was 12%. A total of 38.5% of patients arriving at the hospitals required major surgical intervention. Emergency surgical operations were mainly orthopedic (external fixation for compound fractures) and general surgical interventions (abdominal explorations for penetrating bullet/shrapnel injuries).

Conclusions: The use of heavy-duty automatic weapons, explosives, hostages, and arson in these terrorist attacks alerts us to new challenges to medical counterterrorism response. The need for building central medical control for a coordinated response and for strengthening public hospital capacity are lessons learned for future attacks. These particular terrorist attacks had global consequences, in terms of increased security checks and alerts for and fears of further similar “Mumbai-style” attacks. The resilience of the citizens of Mumbai is a critical measure of the long-term effects of terror attacks.

(Disaster Med Public Health Preparedness. 2011;5:273–279)

Background: Mental health issues are a significant concern after disasters such as the Deepwater Horizon oil spill in the Gulf of Mexico in 2010. This study was designed to assess the mental health effects on residents of areas of southeastern Louisiana affected by the oil spill.

Methods: Telephone and face-to-face interviews were conducted with residents (N = 452) assessing concerns and direct impact.

Results: The results show that the greatest effect on mental health related to the extent of disruption to participants' lives, work, family, and social engagement, with increased symptoms of anxiety, depression, and posttraumatic stress. Given the location of the oil spill affecting communities that had been devastated by Hurricane Katrina, results also revealed that losses from Hurricane Katrina were highly associated with negative mental health outcomes. Conversely, the ability to rebound after adversity and place satisfaction were highly associated with better mental health outcomes.

Conclusions: Enhanced understanding of mental health effects after the Deepwater Horizon oil spill will help in determining directions for much-needed mental health services after the disaster and in contributing to the knowledge of complex traumatization and the ability to rebound after adversity.

(Disaster Med Public Health Preparedness. 2011;5:280–286)

Background: On June 8 and 9, 2008, more than 4 inches of rain fell in the Iowa-Cedars River Basin causing widespread flooding along the Cedar River in Benton, Linn, Johnson, and Cedar Counties. As a result of the flooding, there were 18 deaths, 106 injuries, and over 38 000 people displaced from their homes; this made it necessary for the Iowa Department of Health to conduct a rapid needs assessment to quantify the scope and effect of the floods on human health.

Methods: In response, the Iowa Department of Public Health mobilized interview teams to conduct rapid needs assessments using Geographic Information Systems (GIS)-based cluster sampling techniques. The information gathered was subsequently employed to estimate the public health impact and significant human needs that resulted from the flooding.

Results: While these assessments did not reveal significant levels of acute injuries resulting from the flood, they did show that many households had been temporarily displaced and that future health risks may emerge as the result of inadequate access to prescription medications or the presence of environmental health hazards.

Conclusions: This exercise highlights the need for improved risk communication measures and ongoing surveillance and relief measures. It also demonstrates the utility of rapid needs assessment survey tools and suggests that increasing use of such surveys can have significant public health benefits.

(Disaster Med Public Health Preparedness. 2011;5:287–292)

Objectives: To assess and compare the prevalence of psychological morbidity among survivors of the 2005 northern Pakistan earthquake from Azad Kashmir and the Northwest Frontier Province (NWFP).

Methods: We conducted a cross-sectional study among randomly sampled survivors (N = 361) of the earthquake living in camps at the time of the interview, approximately 6 months after the earthquake.

Results: The prevalence of posttraumatic stress disorder (PTSD) symptoms in the total sample was 51.5% and the prevalence of individuals who received positive scores on the Hopkins Symptom Checklist (HSCL) was 75%. The prevalence rates for anxiety and depression symptoms were 77.3% and 70.9%, respectively. The prevalence in Azad Kashmir was 57.9% for PTSD and 79.8% for positive HSCL, and NWFP had 41.3% PTSD and 67.4% positive HSCL. Study subjects from Azad Kashmir were approximately 2 times as likely to have PTSD or a positive HSCL when compared to subjects from NWFP (odds ratio 1.95, confidence interval 1.27-3.0; P = .0024) and (odds ratio 1.91, confidence interval 1.18-3.1; P = .0085), respectively.

Conclusions: Nearly half of the northern Pakistan earthquake survivors had symptoms of PTSD. Six months after the incident, more than three-fourths exhibited symptoms of an anxiety disorder.

(Disaster Med Public Health Preparedness. 2011;5:293–299)

Objectives: We conducted a county-wide survey to assess the ability and willingness of health care workers to report to work during a pandemic influenza and a severe earthquake and to identify barriers and strategies that would help them report to work.

Methods: A stratified random sample of 9211 health care workers was selected from the Washington state licensure database and from health care agencies. We assessed correlates between self-reported ability and willingness to report to work and demographic and employer-related variables under two scenarios, influenza pandemic and a severe earthquake.

Results: For the influenza pandemic scenario, 95% of respondents reported that they would be able and 89% reported that they would be willing to report to their usual place of work. Seventy-four percent of respondents reported that they would be able and 88% would be willing to report to their usual place of work following a severe earthquake. The most frequently cited strategies that would help respondents report to work during an influenza pandemic were the availability of anti-viral influenza treatment and the ability to work from home. For persons with children at home, the strategy to increase ability to report to work during an earthquake was the availability of child care.

Conclusions: The majority of the King County health care workforce is willing and able to respond to an influenza pandemic or a severe earthquake.

(Disaster Med Public Health Preparedness. 2011;5:300–308)

Disaster response requires rapid, complex action by multiple agencies that may rarely interact during nondisaster periods. Failures in communication and coordination between agencies have been pitfalls in the advancement of disaster preparedness. Recommendations of the Federal Emergency Management Agency address these needs and demonstrate commitment to successful disaster management, but they are challenging for communities to ensure. In this article we describe the application of Federal Emergency Management Agency guidelines to the 2008 and 2009 Chicago Marathon and discuss the details of our implementation strategy with a focus on optimizing communication. We believe that it is possible to enhance community disaster preparedness through practical application during mass sporting events.

(Disaster Med Public Health Preparedness. 2011;5:310–315)