The aim of this study was to analyze congestive heart failure (CHF) discharges in Florida (USA) post tropical cyclones from 2007 through 2017.

This was a retrospective longitudinal time series analysis of hospital CHF quarterly discharges across Florida using the Healthcare Cost and Utilization Project (HCUP) database. The autoregressive integrated moving average (ARIMA) model was used with correlated seasonal regressor variables such as cyclone frequency, maximum cyclone wind speed, average temperature, and reports of influenza-like illness (ILI).

A total of 3,372,993 patients were identified, with average age in each quarter ranging 72.2 to 73.9 years and overall mortality ranging 4.3% to 6.4%. The CHF discharges within each year peaked from October through December and nadired from April through June with an increasing overall time trend. Significant correlation was found between CHF discharge and the average temperature (P <.001), with approximately 331.8 less CHF discharges (SE = 91.7) per degree of increase in temperature. However, no significant correlation was found between CHF discharges and frequency of cyclones, the maximum wind speed, and reported ILI.

This study suggests that with the current methods and the HCUP dataset, there is no significant increase in overall CHF discharges in Florida as a result of recent previous cyclone occurrences.

Road traffic collisions (RTC) result in a significant number of preventable deaths worldwide. In 2010, the United Nations General Assembly launched, “The Decade of Action for Road Safety (2011–2020)” with the stated goal to “reduce road traffic deaths and injuries by 50% by 2020.” This study aims to analyze trends in RTC numbers and subsequent deaths with respect to road safety laws in Nigeria and to suggest suitable interventions.

Annual reports for the period 2007–2017 were obtained from the Federal Road Safety Corps of Nigeria. These reports were analyzed for trends in RTC, including reported causes, fatalities, injuries, and casualties.

Overall total injuries, casualties, and fatalities increased by 74.7%, 61.2%, and 9.6%, respectively. Analysis showed that the 3 main causes of RTC were speed violation, loss of control, and dangerous driving.

Although current trends do not suggest that Nigeria will accomplish its initial goal of decreasing fatalities by 50% by 2020, there has been a reduction in the number of crashes resulting from dangerous driving. Further interventions such as implementing automated speed monitoring, collaboration, and data sharing between federal and regional agencies, and improving the state of road networks should be implemented to decrease fatalities further.

In 2009, the Institute of Medicine published guidelines for implementation of Crisis Standards of Care (CSC) at the state level in the United States (US). Based in part on the then concern for H1N1 pandemic, there was a recognized need for additional planning at the state level to maintain health system preparedness and conventional care standards when available resources become scarce. Despite the availability of this framework, in the years since and despite repeated large-scale domestic events, implementation remains mixed.

Coronavirus disease 2019 (COVID-19) rejuvenates concern for how health systems can maintain quality care when faced with unrelenting burden. This study seeks to outline which states in the US have developed CSC and which areas of care have thus far been addressed.

An online search was conducted for all 50 states in 2015 and again in 2020. For states without CSC plans online, state officials were contacted by email and phone. Public protocols were reviewed to assess for operational implementation capabilities, specifically highlighting guidance on ventilator use, burn management, sequential organ failure assessment (SOFA) score, pediatric standards, and reliance on influenza planning.

Thirty-six states in the US were actively developing (17) or had already developed (19) official CSC guidance. Fourteen states had no publicly acknowledged effort. Eleven of the 17 public plans had updated within five years, with a majority addressing ventilator usage (16/17), influenza planning (14/17), and pediatric care (15/17), but substantially fewer addressing care for burn patients (9/17).

Many states lacked publicly available guidance on maintaining standards of care during disasters, and many states with specific care guidelines had not sufficiently addressed the full spectrum of hazard to which their health care systems remain vulnerable.

Colombia is the fourth largest country in South America. It is an upper middle-income country with an estimated population of 49.2 million people, and road traffic collisions (RTCs) are the second most common cause of traumatic death. The United Nations (UN) proclaimed 2011 to 2020 as the “Decade of Action for Road Safety.” In this context, the government of Colombia established the National Road Safety Plan (PNSV) for the period 2011-2021, aiming to reduce RTC-related deaths by 26%. Some road safety laws (RSLs) were implemented before the PNSV, but their impact on deaths and injuries is still not known.

The aim of this study was to evaluate whether these RSLs have had a long-term effect on road safety in the country.

Data on RTC casualties, deaths, and injuries from January 1, 2001 through December 31, 2017 were collated from official Colombian governmental publications. Three different periods were considered for analysis: 2001-2010 to evaluate the Transit Code; 2011-2017 to evaluate the PNSV; and 2001-2017 to evaluate a composite of the full study period. Analyses of trends in deaths and injuries were related to dates of new RSLs.

A total of 102,723 deaths (12.7%) and 707,778 injuries (87.3%) were reported from 2001 through 2017. The Transit Code period (2001-2010) showed a 10.1% decline in deaths, 16.6% decline in injuries, and rates per 100,000 inhabitants and per 10,000 registered vehicles also declined. During the period of the PNSV (2011-2017), there was an increase in the number of deaths by 16.6%, injuries decreased by 1.7%, and death rates per 100,000 inhabitants also increased. During the total study period, a 12.4% reduction in the total number of casualties was achieved, and death and injury rates per 100,000 inhabitants decreased by 12.4% and 27.5%, respectively.

Despite the introduction of the PNSV, RTCs remain the second most common cause of preventable death in Colombia. Overall, while the absolute number of RTCs and deaths has been increasing, the rate of RTCs per 10,000 registered vehicles has been decreasing. This suggests that although the goals of the PNSV may not be realized, some of the laws emanating from it may be having a beneficial effect. Further study is required over a protracted period to determine the longer-term impact of these initiatives.

Disasters are high-acuity, low-frequency events which require medical providers to respond in often chaotic settings. Due to this infrequency, skills can atrophy, so providers must train and drill to maintain them. Historically, drilling for disaster response has been costly, and thus infrequent. Virtual Reality Environments (VREs) have been demonstrated to be acceptable to trainees, and useful for training Disaster Medicine skills. The improved cost of virtual reality training can allow for increased frequency of simulation and training.

The problem addressed was to create a novel Disaster Medicine VRE for training and drilling.

A VRE was created using SecondLife (Linden Lab; San Francisco, California USA) and adapted for use in Disaster Medicine training and drilling. It is easily accessible for the end-users (trainees), and is adaptable for multiple scenario types due to the presence of varying architecture and objects. Victim models were created which can be role played by educators, or can be virtual dummies, and can be adapted for wide ranging scenarios. Finally, a unique physiologic simulator was created which allows for dummies to mimic disease processes, wounds, and treatment outcomes.

The VRE was created and has been used extensively in an academic setting to train medical students, as well as to train and drill disaster responders.

This manuscript presents a new VRE for the training and drilling of Disaster Medicine scenarios in an immersive, interactive experience for trainees.

Disaster Medicine (DM) education for Emergency Medicine (EM) residents is highly variable due to time constraints, competing priorities, and program expertise. The investigators’ aim was to define and prioritize DM core competencies for EM residency programs through consensus opinion of experts and EM professional organization representatives.

Investigators utilized a modified Delphi methodology to generate a recommended, prioritized core curriculum of 40 DM educational topics for EM residencies.

The DM topics recommended and outlined for inclusion in EM residency training included: patient triage in disasters, surge capacity, introduction to disaster nomenclature, blast injuries, hospital disaster mitigation, preparedness, planning and response, hospital response to chemical mass-casualty incident (MCI), decontamination indications and issues, trauma MCI, disaster exercises and training, biological agents, personal protective equipment, and hospital response to radiation MCI.

This expert-consensus-driven, prioritized ranking of DM topics may serve as the core curriculum for US EM residency programs.

Human stampedes (HS) may result in mass casualty incidents (MCI) that arise due to complex interactions between individuals, collective crowd, and space, which have yet to be described from a physics perspective. HS events were analyzed using basic physics principles to better understand the dynamic kinetic variables that give rise to HS.

A literature review was performed of medical and nonmedical sourced databases, Library of Congress databases, and online sources for the term human stampedes resulting in 25,123 references. Filters were applied to exclude nonhuman events. Retrieved references were reviewed for a predefined list of physics terms. Data collection involved recording frequency of each phrase and physics principle to give the final proportions of each predefined principle used a single-entry method for each of the 105 event reports analyzed. Data analysis was performed using the R statistics packages “tidyverse”, “psych”, “lubridate”, and “Hmisc” with descriptive statistics used to describe the frequency of each observed variable.

Of the 105 reports of HS resulting in injury or death reviewed, the following frequency of terms were found: density change in a limited capacity, 45%; XY-axis motion failure, 100%; loss of proxemics, 100%; deceleration with average velocity of zero, 90%; Z-axis displacement pathology (falls), 92%; associated structure with nozzle effect, 93%; and matched fluid dynamic of high pressure stagnation of mass gathering, 100%.

Description or reference to principles of physics was seen in differing frequency in 105 reports. These include XY-axis motion failure of deceleration that leads to loss of human to human proxemics, and high stagnation pressure resulting in the Z-axis displacement effect (falls) causing injury and death. Real-time video-analysis monitoring of high capacity events or those with known nozzle effects for loss of proxemics and Z-axis displacement pathology offers the opportunity to prevent mortality from human stampedes.

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.

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.

In the past five decades, the region of Latin America and the Caribbean (LAC) has been subject to several types of terrorist attacks, with most committed by local terrorist organizations. However, there have also been attacks by international terrorist groups. Internationally, terrorist attacks are increasing in both frequency and complexity. Significant concerns exist regarding the use of Chemical Warfare Agents (CWAs) in civilian settings. Asphyxiants (e.g. cyanide), opioids (e.g. fentanyl), and nerve agents (e.g. sarin) represent some of the most lethal CWAs. To date, there is very little published data on their use in the LAC region despite the fact that the recent attacks in Syria have sparked international interest in the use and regulation of CWAs.

To improve civilian health service preparedness in response to CWAs attacks by describing the types of agents historically used within the LAC region.

Information was extracted and analyzed from the open-source Global Terrorist Database hosted by the University of Maryland, regarding CWA-LAC from January 1, 1970, to December 31, 2017.

During the forty-seven year period reviewed, there were 29,846 terrorist attacks in the LAC region, with 63.6% occurring in the southern region. Twenty-nine CWA attacks were reported, with the most common agents being tear gas (37%) and cyanide (29.6%). The most frequent targets were religious figures/institutions (22.2%), law enforcement (18.5%), and government agencies/personnel (18.5%).

Cyanide is one of the most prevalent agents used for chemical weapons attacks in the LAC region. Preparedness should be enhanced for CWA terrorist attacks, especially those involving cyanide, given its life-threatening nature, prevalence, and the existence of reversal agents. First responders, physicians, and nurses should be aware of this potential hazard and be trained to respond appropriately. Additionally, regional stockpiles of antidotes should be considered by governmental bodies within the LAC region.

Road traffic collisions (RTC) are the leading cause of preventable death among those aged 15–29 years worldwide. More than 1.2 million lives are lost each year on roads. Ninety percent of these deaths take place in low- and middle-income countries. The General Assembly of the United Nations (UN) proclaimed the period from 2011-2020 the “Decade of Action for Road Safety,” with the objective of stabilizing and reducing the number of deaths by 50% worldwide. In this context, the government of Colombia established the National Road Safety Plan (PNSV) for the period 2011–2021 with the objective of reducing the number of fatalities by 26%. However, the effectiveness of road safety policies in Colombia is still unknown.

To evaluate the effect of road safety laws on the incidence of RTC, deaths, and injuries in Colombia.

RTC data and fatality numbers for the time period of January 1, 2010, to December 31, 2017, were collated from official Colombian governmental publications and analyzed for reductions and trends related to the introduction of new road safety legislation.

Data analysis are expected to be completed by January 2019.

RTC remains the leading preventable cause of death in Colombia despite the PNSV. Data is being mined to determine the trends of these rates of crashes and fatalities, and their relation to the introduction of national traffic laws. Overall, while the absolute numbers of RTC and deaths have been increasing, the rate of RTC per 10,000 cars has been decreasing. This suggests that although the goals of the PNSV may not be realized, some of the laws emanating from it may be beneficial, but warrant further detailed analysis.

Opioid overdose deaths in the United States are increasing. Time to restoration of ventilation is critical. Rapid bystander administration of opioid antidote (naloxone) is an effective interim response but is historically constrained by legal restrictions.

To review and contextualize development of legislation facilitating layperson administration of naloxone across the United States.

Publicly accessible databases (1,2) were searched for legislation relevant to naloxone administration between January 2001 and July 2017.

All 51 jurisdictions implemented naloxone access laws between 2001 and 2017; 45 of these between 2012 and 2017. Nationwide mortality from opioid overdose increased from 3.3 per 100,000 population in 2001 to 13.3 in 2016, 42, and 35 jurisdictions enacted laws giving prescribers immunity from criminal prosecution, civil liability, and professional sanctions, respectively. 36, 41, and 35 jurisdictions implemented laws allowing dispensers immunity in the same domains. 38 and 46 jurisdictions gave laypeople administering naloxone immunity from criminal and civil liability. Forty-seven jurisdictions implemented laws allowing prescription of naloxone to third parties. All jurisdictions except Nebraska allowed pharmacists to dispense naloxone without a patient-specific prescription. Fifteen jurisdictions removed criminal liability for possession of non-prescribed naloxone. The 10 states with highest average rates of opioid overdose-related mortality had not legislated in a higher number of domains compared to the 10 lowest states and the average of all jurisdictions (3.4 vs 2.9 vs 2.7, respectively).

Effective involvement of bystanders in early recognition and reversal of opioid overdose requires removal of legal deterrents to prescription, dispensing, distribution, and administration of naloxone. Jurisdictions have varied in degree and speed of creating this legal environment. Understanding the integration of legislation into epidemic response may inform the response to this and future public health crises.

Human Stampedes (HS) occur at religious mass gatherings. Religious events have a higher rate of morbidity and mortality than other events that experience HS. This study is a subset analysis of religious event HS data regarding the physics principles involved in HS, and the associated event morbidity and mortality.

To analyze reports of religious HS to determine the initiating physics principles and associated morbidity and mortality.

Thirty-four reports of religious HS were analyzed to find shared variables. Thirty-three (97.1%) were written media reports with photographic, drawn, or video documentation. 29 (85.3%) cited footage/photographs and 1 (2.9%) was not associated with visual evidence. Descriptive phrases associated with physics principles contributing to the onset of HS and morbidity data were extracted and analyzed to evaluate frequency before, during, and after events.

34 (39.1%) reports of HS found in the literature review were associated with religious HS. Of these, 83% were found to take place in an open space, and 82.3% were associated with population density changes. 82.3% of events were associated with architectural nozzles (small streets, alleys, etc). 100% were found to have loss of XY-axis motion and 89% reached an average velocity of zero. 100% had loss of proxemics and 91% had associated Z-axis displacement (falls). Minimum reported attendance for a religious HS was 3000. 100% of religious HS had reported mortality at the event and 56% with further associated morbidity.

HS are deadly events at religious mass gatherings. Religious events are often recurring, planned gatherings in specific geographic locations. They are frequently associated with an increase in population density, loss of proxemics and velocity, followed by Z-axis displacements, leading to injury and death. This is frequently due to architectural nozzles, which those organizing religious mass gatherings can predict and utilize to mitigate future events.