Floods are the most common hazard to cause disasters and have led to extensive morbidity and mortality throughout the world. The impact of floods on the human community is related directly to the location and topography of the area, as well as human demographics and characteristics of the built environment.

The aim of this study is to identify the health impacts of disasters and the underlying causes of health impacts associated with floods. A conceptual framework is developed that may assist with the development of a rational and comprehensive approach to prevention, mitigation, and management.

This study involved an extensive literature review that located >500 references, which were analyzed to identify common themes, findings, and expert views. The findings then were distilled into common themes.

The health impacts of floods are wide ranging, and depend on a number of factors. However, the health impacts of a particular flood are specific to the particular context. The immediate health impacts of floods include drowning, injuries, hypothermia, and animal bites. Health risks also are associated with the evacuation of patients, loss of health workers, and loss of health infrastructure including essential drugs and supplies. In the medium-term, infected wounds, complications of injury, poisoning, poor mental health, communicable diseases, and starvation are indirect effects of flooding. In the long-term, chronic disease, disability, poor mental health, and poverty-related diseases including malnutrition are the potential legacy.

This article proposes a structured approach to the classification of the health impacts of floods and a conceptual framework that demonstrates the relationships between floods and the direct and indirect health consequences.

As Hurricane Katrina bore down on New Orleans in August 2005, the city's mandatory evacuation prompted the exodus of an estimated 80% of its 485,000 residents. According to estimates from the US Centers for Disease Control and Prevention (CDC), at least 18 states subsequently hosted >200,000 evacuees.

In this case study, “Operation Helping Hands” (OHH), the Massachusetts health and medical response in assisting Hurricane Katrina evacuees is described. Operation Helping Hands represents the largest medical response to evacuees in recent Massachusetts history.

The data describing OHH were derived from a series of structured interviews conducted with two leading public health officials directing planning efforts, and a sample of first responders with oversight ofoperations at the evacuation site. Also, a literature review was conducted to identify similar experiences, common challenges, and lessons learned.

Activities and services were provided in the following areas: (1) administration and management;(2) medical and mental health; (3) public health; and (4) social support. This study adds to the knowledge base for future evacuation and shelter planning, and presents a conceptual framework that could be used by other researchers and practitioners to describe the process and out comes of similar operations.

This study provides a description of the planning and implementation efforts of the largest medical evacuee experience in recent Massachusetts history, an effort that involved multiple agencies and partners. The conceptual framework can inform future evacuation and shelter initiatives at the state and national levels, and promotes the overarching public health goal of the highest attainable standard of health for all.

Accurate estimation of a patient's age and weight are skills expected of all healthcare clinicians, including paramedics and nurses. It is necessary because patients may be unable to communicate such information due to unconsciousness or an altered state of conscious. Age and weight estimation influence calculation for medication dosages, defibrillation, equipment sizing, and other invasive procedures such as intubation. The objective of this study was to identify whether undergraduate paramedic and nursing students were able to accurately estimate a patient's age and weight based on digital patient photos.

A prospective, observational study involving undergraduate paramedic and nursing students from two Australian universities was used to estimate the age and weight of seven patients (adult and pediatric). Each patient image appeared in a PowerPointTM presentation for 15 seconds, followed by a short pause, with the next patient image commencing automatically.

The findings demonstrated variable accuracy in age and weight estimation of the patients. Age estimations of pediatric patients were more accurate than estimations for adult patients. The majority of patient weights were under-estimated, with university undergraduate students in one university displaying similar estimations to the other university counterparts.

Results from this study identified variations in students' ability to accurately estimate a patient's age and weight. This study shows that consideration should be given to age and weight estimation education, which could be incorporated into undergraduate healthcare curriculum.

Four weeks after the earthquake in Kashmir, Pakistan, multi-disciplinary surgical teams were organized within the United Kingdom to help treat disaster victims who had been transferred to Rawalpindi. The work of these teams between 05-17 November 2005 is reviewed, and experiences and lessons learned are presented.

Two self-sufficient teams consisting of orthopedic, plastic surgical, anesthetic, and theatre staff were deployed consecutively over a two-week period. A trauma unit was set up in a donated ward within a private ophthalmological hospital in Rawalpindi.

Seventy-eight patients with a mean age of 23 years were treated: more than half (40) were <16 years of age. Fifty-two patients only had lower limb injuries, 18 upper limb injuries, and eight combined lower and upper limb. The most common types of injuries were: (1) tibial fractures (n = 24), with the majority being open grade 3B injuries (n = 22); (2) femoral fractures (n = 11); and (3) forearm fractures (n = 9). Almost half (n = 34) of the fractures were open injuries requiring soft tissue cover.

Over 12 days, 293 operations were performed (average 24.4 per day). A total of 202 examinations under anesthesia, washouts, and debridements were performed. The majority of wounds required multiple washouts prior to definitive procedures. Thirty-four definitive orthopedic procedures (fixations) and 57 definitive plastic procedures were performed. Definitive orthopedic procedures included 15 circular frame fixations of long bones, nine of which required acute shortening and five open reduction and internal fixation of long bones. Definitive plastic procedures included 21 skin grafts, four amputations, 11 revisions of amputations, 20 regional flaps, and one free flap.

A joint ortho-plastic approach was key to the treatment of the spectrum of injuries encountered. Only four patients required fresh amputations. Twenty patients may have required amputation without the use of ring fixators and soft tissue reconstruction. Having self-sufficient teams along with their own equipment and supplies also was mandatory in order not to put further demand on already scarce resources. However, mobilizing such teams logistically was difficult, and therefore, an organization consisting of willing volunteers for future efforts has been established.

Standard gauze field dressings and direct pressure occasionally are inadequate for the control of hemorrhage. QuikClot® Combat Gauze™ (QCG) combines surgical gauze with an inorganic material and is approved by the Food and Drug Administration and by the Israeli Standards Institute for external hemorrhage control. The purpose of this article is to report clinical use of this dressing during Operation Cast Lead in the Gaza strip during January 2009.

QuikClot Combat Gauze and the QCG guidelines were issued to advanced life support (ALS) providers during the preparations for the Operation.

All cases of injuries involving hemorrhage were reviewed, as well as interviews with the ALS providers (physicians and paramedics) and injured soldiers.

Fourteen uses of QCG were reported and reviewed (out of a total of 56 hemostatic interventions in 35 cases). Dressings were applied to injuries to the head, neck, axilla, buttocks, abdomen, back, and pelvis in 10 cases, and to extremities in four cases. In 13 cases (93%), injuries were caused by blast or gunshot mechanisms. The success rate was reported as 79% (11/14). Failure to control hemorrhage was reported in three cases in three different locations: neck, buttock, and thigh. All failures were attributed to severe soft tissue and vascular injuries. No complications or adverse events were reported.

This report on the clinical field use of the QCG dressing by ALS providers suggests that it is an effective and safe product, and applicable for prehospital treatment of combat casualties. This report further suggests that QCG should be issued to medics as well as ALS providers. Larger clinical investigations are needed to confirm these findings.

World Youth Day (WYD) and its associated activities were held in Sydney, Australia from 15–20 July 2008. The aims of this research were to pilot the use of postcards at mass gatherings and to collect baseline data of how young people (age 16–25 years) identify factors that may affect their health and safety when attending mass gatherings.

The concerns of young people in relation to their health and safety at mass gatherings are poorly understood. It was decided that postcards would be an effective method of data collection in the mobile mass gathering environment.

The research setting was the Pilgrim Walk at WYD. Participants on this walk were young people. To measure their health and safety concerns, a postcard was developed using a Likert scale to rank their attitudes on a continuum.

Young people stated that staying hydrated, having enough to eat, and being safe in a crowd were important to them. They also indicated that they perceived, overcrowding, getting to and from an event, and violent behavior as the greatest risks to their health and safety at a mass gathering.

The problems with postcard distribution at a “mobile” mass gathering have been identified. Even so, results gathered showed that young people were focused on “in the moment” aspects of their health; such as access to food and water. They also had concerns for their safety due to potential overcrowding and/or violent behavior.

The impact of the use of mask continuous positive airway pressure (CPAP) on patients with acute respiratory distress in the prehospital, rural setting has not been defined. The goal was to test the use of CPAP using the Respironics® WhisperFlow® CPAP in patients presenting with acute respiratory distress. This was a collaborative evaluation of CPAP involving a rural EMS agency and the regional medical center. Patient outcomes including the overall rate of intubation-both in the field and in the emergency department (ED), and length of stay in the hospital and Intensive Care Unit (ICU) were tracked.

The study was an eight-month, crossover, observational, non-blinded study.

During the four months of baseline data collection, 7.9% of patients presenting with respiratory distress were intubated within the first 48 hours of care. Their average ICU length of stay was 8.0 days. During the four months of data collection when CPAP was available in the prehospital setting, intubation was not required for any patients in the field or in the ED. Admissions to the ICU decreased. Those patients admitted to the ICU, the average ICU length of stay deceased to 4.3 days.

The use of the CPAP in the prehospital setting is beneficial for patients in acute respiratory distress.

In October 2007, San Diego County experienced a severe firestorm resulting in the burning of more than 368,000 acres, the destruction of more than 1,700 homes, and the evacuation of more than 500,000 people.

The goal of this study was to assess the impact of the 2007 San Diego Wildfires, and the acute change in air quality that followed, on the patient volume and types of complaints in the emergency department.

A retrospective review was performed of a database of all patients presenting to the Emergency Departments of University of California, San Diego (UCSD) hospitals for a six-day period both before (14–19 October 2007) and after (21–26 October 2007) the start of the 2007 firestorm. Charts were abstracted for data, including demographics, chief complaints, past medical history, fire-related injuries and disposition status. As a measure of pollution, levels of 2.5 micron Particulate Matter (PM 2.5) also were calculated from data provided by the San Diego Air Pollution Control District.

Emergency department volume decreased by 5.8% for the period following the fire. A rapid rise in PM2.5 levels coincided with the onset of the fires. The admission rate was higher in the period following the fires (19.8% vs. 15.2%) from the baseline period. Additionally, the Left Without Being Seen (LWBS) rate doubled to 4.6% from 2.3%. There was a statistically significant increase in patients presenting with a chief complaint of shortness of breath (6.5% vs. 4.2% p = 0.028) and smoke exposure (1.1% vs. 0% p = 0.001) following the fires. Patients with significant cardiac or pulmonary histories were no more likely to present to the emergency department during the fires.

Despite the decreased volume, the admission and LWBS rate did increase following the onset of the firestorm. The cause of this increase is unclear. Despite a sudden decline in air quality, patients with significant cardiac and pulmonary morbidity did not vary their emergency department utilization rate. Based on the experience at UCSD, it appears that significant wildfires like that seen in 2007, only may marginally affect emergency department operations, and may not require significant changes to normal staffing levels.

There is a scarcity of analytical data regarding mass-gathering medical care. The purpose of this study was to identify and evaluate the range and nature of illness and injury for patrons of an annual, multi-day, mass gathering.

Encounter data from all patients seen by emergency physicians at the New York State Fair Infirmary during the past five years were analyzed. From these data, a category list was consolidated to 36 reasons for the visit based on chief complaint, nursing notes, and physician notes. The most common reasons for being seen by a physician were analyzed to determine age and gender discrepancies.

The average number of attendees at the Fair per year from 2004–2008 was 950,973. Emergency physicians evaluated a total of 2,075 patients from 2004–2008. The average patient presentation rate over the past four years (2005–2008) was 4.8 ±1.1/10,000 patrons. The average transport to hospital rate over the past four years was 2.7 ±1.1/100,000 patrons. The average age of all patients seen was 34.4 ±21.6 years, and 58.1% of the patients were female. The most common reasons to seek medical attention included: dehydration/heat-related illness (11.4%); abrasion/laceration (10.6%); and fall-related injury (10.2%). Two groups, dehydration/heat-related illness 74% (t (4) = 2.90, p <0.05), and fall-related injury (68%; t (4) = 5.17, p <0.05) were disproportionately female. There also was a direct relationship between age and female gender within the fall-related injury category (χ2 (1, n = 213) = 11.41, p <0.05).

Patron data from fairs and expositions is a valuable resource for studying mass-gathering medical care. A majority (58%) of patients seen at the infirmary were female. The most common reason for being seen was dehydration/ heat-related illness, which heavily favored females, but favored no age groups. The abrasion/laceration category did not contribute to the gender discrepancy. Patients who fell tended to be females >40 years of age. Further analysis is required to determine the reason for the gender discrepancies. Planners of multi-day mass gatherings should develop public education programs and evaluate their impact on the at-risk populations identified by this analysis.