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Every year, there are larger and more severe disasters and health organizations are struggling to respond with services to keep public health systems running. Making decisions with limited health information can negatively affect response activities and impact morbidity and mortality. An overarching challenge is getting the right health information to the right health service personnel at the right time. As responding agencies engage in social media (eg, Twitter, Facebook) to communicate with the public, new opportunities emerge to leverage this non-traditional information for improved situational awareness. Transforming these big data is dependent on computers to process and filter content for health information categories relevant to health responders. To enable a more health-focused approach to social media analysis during disasters, 2 major research challenges should be addressed: (1) advancing methodologies to extract relevant information for health services and creating dynamic knowledge bases that address both the global and US disaster contexts, and (2) expanding social media research for disaster informatics to focus on health response activities. There is a lack of attention on health-focused social media research beyond epidemiologic surveillance. Future research will require approaches that address challenges of domain-aware, including multilingual language understanding in artificial intelligence for disaster health information extraction. New research will need to focus on the primary goal of health providers, whose priority is to get the right health information to the right medical and public health service personnel at the right time.
Nowadays, extreme weather and atmospheric conditions are becoming more frequent and more intense. It seems obvious that together with climate change, the vulnerability of the public and of individual regions to the risks of various types of natural hazards also increases. This would increase the importance of organization concerning potential measures to protect against these extraordinary events, and to prepare for reducing their ramifications.
One such initiative is the creation of an early warning system for inhabitants of a given area of a country, to help guard against the extraordinary threat associated with a natural disaster; especially floods. The creation of such a system is aimed at increasing public safety and limiting losses caused by the occurrence of natural, technological, and synergistic hazards. Particular emphasis during the construction of a current system is placed on supporting flood risk management, which is aimed at increasing the safety of citizens and reducing losses caused by the occurrence of flooding in Poland. This would be possible by the identification of areas threatened by flooding throughout the country, and then limiting economic expansion in these areas.
Ultimately, the project aims to consolidate information regarding hazardous events and gather them in a professional Information Technology (IT) system, using an integrated database and a modern module for disseminating information to end users. The system is to provide access to this information for both the administration and the individual citizen.
This article presents the potential of a so called “IT System for the Country’s Protection Against Extreme Hazards,” which is currently being developed in Poland, with particular emphasis on reducing the risks related to natural disasters and minimizing the problems of crisis management in Poland. This article is also aimed at opening discussions and creating a basis for the exchange of information from countries implementing similar solutions, especially neighboring countries, with which joint action could be undertaken.
Herd immunity, a concept normally applied in vaccinated populations, is a preventative measure to determine if a significant portion of a population can protect vulnerable individuals against a certain disease. Like vaccines, tourniquet education can be a form of herd immunity to protect vulnerable individuals in a population and prevent the loss of life from a peripheral hemorrhage. The authors have identified a deficiency in simple, quick, and effective hemorrhage control education. Therefore, to maximize herd immunity, the novel educational platform evaluates the efficacy of “Just-in-Time” (JiT) tourniquet application training.
The authors hypothesize that the utilization of JiT training will be effective in promoting both competence and confidence for individuals to utilize tourniquets in response to a disaster environment.
This Institutional Review Board-approved study recruited medical students who were trained in hemorrhage control measures at a Level 1 Trauma Center. Tourniquet training sessions were held, and naïve civilians received tourniquet education. The subjects received a five- to ten-minute lesson on indications, contraindications, and application techniques of commercial and improvisational tourniquets. Participants subsequently applied a tourniquet to an instructor’s arm to demonstrate proper tourniquet application for a brachial artery hemorrhage. Pre- and post-educational surveys were completed to test participant competency and confidence.
Of the 104 subjects who completed the course, 97 had no prior training in hemorrhage control techniques, including commercial and improvisational tourniquet application. The mean pre-test score was 2.27/5.00 and the mean post-test score was 4.38/5.00, P <.001 (n = 97). When queried “How competent would you feel applying a tourniquet (commercial or improvisational) on an individual with a bleeding wound?” 92/97 felt confident (95%), one felt less confident, and four felt no difference in confidence levels (P <.001).
Just-in-Time training is an effective method in teaching naïve civilians proper tourniquet application. This platform could serve as an alternative to more extensive training programs and requires less time, costs, and resources. If a significant number of individuals in a local community can effectively apply a tourniquet in a disaster scenario, a “herd immunity” effect could be achieved to control peripheral hemorrhages.
This study empirically examines preparedness with a kit, medication, and a disaster plan on disaster outcomes including perceived recovery, property damage, and use of medical or mental health services.
Using a cross-sectional, retrospective study design, 1114 households in New York City were interviewed 21-34 months following Super Storm Sandy. Bivariate associations were examined and logistic regression models fit to predict the odds of disaster outcomes given the level of preparedness.
Respondents with an evacuation plan were more likely to report not being recovered (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.5-3.8), property damage (OR =1.4; 95% CI: 1.1-1.9), and use of medical services (OR = 2.3; 95% CI: 1.1-4.5). Respondents reporting a supply of prescription medication were more likely to report using mental health (OR = 3.5; 95% CI: 1.2-9.8) and medical services (OR = 2.3; 95% CI: 1.1-4.8)
Having a kit, plan, and medication did not reduce risk of adverse outcomes in Superstorm Sandy in this sample. Disaster managers should consider the lack of evidence for preparedness when making public education and resource allocation decisions. Additional research is needed to identify preparedness measures that lead to better outcomes for more efficient and effective response and recovery.
The Centers for Disease Control and Prevention developed 15 National Public Health Emergency and Preparedness Response Capabilities (NPHPRCs) to serve as national standards for health-related core capabilities. The objective of this study is to determine the level of federal funding allocated for research related to NPHPRCs during 2008–2017.
An online search of http://www.USAspending.gov was performed to identify federal awards, grants, contracts from 2008–2017 related to research associated with NPHPRCs. Inclusion criteria were identifiable as research and disaster-related; US-based; and specific reference to any of the NPHPRCs. A panel of 3 experts reviewed each entry for inclusion.
The search identified 15 278 transactions representing US $29.2 billion in awards. After exclusions, 93 entries were found to be related to NPHPRCs, averaging US $2 783 136 annually. Funding notably dropped to US $168 684 in 2010 and ceased entirely in 2016. Ten (67%) of NPHPRCs received funding. Eighty-percent of funding focused on 4 capabilities. Three federal agencies funded 80% of research. Sixteen (24%) of the 47 recipients received 80% of all funding.
US federal investments in research and development related to NPHPRCs have been highly variable over the past decade. One-third of NPHPRCs receive no funding. There are notable gaps in funding, content, continuity, and scope of participation.
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.
In November 2017, a disruptive earthquake occurred in Western Iran. After the major earthquake in Kermanshah, most affordable buildings such as a hospital in Islamabad and a dozen schools were destroyed. According to experts, a dangerous location (construction on the fault), poor quality of concrete, inappropriate connection of the facade to the structure, the use of undesirable construction materials, and low quality of non-structural components are considered as the main reasons for these damages. Regarding the role of government in the developing countries, construction policies should be modified and new policies should be implemented to enhance the structural and non-structural resilience in the buildings.
During disasters, people share their thoughts and emotions on social media and also provide information about the event. Mining the social media messages and updates can be helpful in understanding the emotional state of people during such unforeseen events as they are real-time data. The objective of this review is to explore the feasibility of using social media data for mental health surveillance as well as the techniques used for determining mental health using social media data during disasters. PubMed, PsycINFO, and PsycARTICLES databases were searched from 2009 to November 2018 for primary research studies. After screening and analyzing the records, 18 studies were included in this review. Twitter was the widely researched social media platform for understanding the mental health of people during a disaster. Psychological surveillance was done by identifying the sentiments expressed by people or the emotions they displayed in their social media posts. Classification of sentiments and emotions were done using lexicon-based or machine learning methods. It is not possible to conclude that a particular technique is the best performing one, because the performance of any method depends upon factors such as the disaster size, the volume of data, disaster setting, and the disaster web environment.
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.
In the nearly a quarter of a century since the addition of the clinically significant distress/impairment criterion to the definition of PTSD in DSM-IV, little research has been done to examine the association of this criterion with symptom group criteria and with the numbing subgroup specifically. This study was conducted to examine these relationships in a large database of disaster survivors consistently studied across 12 different incidents of the full range of disaster typology.
Analysis was conducted on a merged database representing 1187 trauma-exposed survivors of 12 different disasters studied systematically. DSM-IV-TR criteria for disaster-related PTSD were assessed with the Diagnostic Interview Schedule.
PTSD Group C (avoidance/numbing) and numbing specifically were less common and more associated than other symptom groups with criterion F (distress/impairment). Consistently in multivariable models, group C and numbing were independently associated with criterion F. Group D (hyperarousal) was less strongly associated with criterion F. Neither group B (intrusion) nor avoidance were associated with criterion F.
In this and other studies, group C and numbing specifically have been shown to be associated with criterion F, which is consistent with the demonstration that group C and the numbing component specifically are central to the psychopathology of PTSD. The addition of the distress/impairment requirement broadly across the psychiatric diagnoses in DSM-IV added little value to PTSD symptom criteria. Future revisions of diagnostic criteria may benefit by carefully considering these findings to possibly re-include a prominent numbing symptom section.
On April 25, 2015, central Nepal was struck by a magnitude 7.8 earthquake that killed over 9,000 people and displaced 2.8 million. The image of the Dharahara, a nineteenth-century minaret that collapsed during the quake, quickly became for many Nepalis an iconic representation not only of the disaster but also of a national determination to recover and rebuild. Drawing upon media and literary discourse in the Nepali language, this article asks why the Dharahara tower, rather than the country's severely damaged World Heritage sites, loomed so large in the Nepali imagination in the immediate aftermath of the April 2015 earthquake, and why it became a rallying point for a resurgence of Nepali hill nationalism.
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.
This article ponders the possibilities existing for legal re-understandings of vulnerability and adopts the International Law Commission's Draft Articles on the Protection of Persons in the Event of Disasters (2016) as its principal discursive context. Despite some promise and potential, the draft Articles retreated to conservative understandings of disaster-vulnerability and missed an opportunity for a sophisticated formulation. This article argues for disaster law's engagement with contemporary social science research. The work of critical geographers, historians and anthropologists in political ecology is particularly apposite. By rejecting geophysical outlooks in favour of structuralist understandings of disaster-vulnerability, such research facilitates consideration of interrelated histories and the role of economics in producing disaster-vulnerability. This article argues that such perspectives allow for reconsideration of current legal understandings regarding disaster-vulnerability (particularly in relation to international cooperation and risk and reduction) and thereby offer some promise for enriching disaster law's comprehensiveness and relevance.
The aim of this systematic review is to investigate the community-based academic partnership roles in disaster risk management.
The assessment of the documents was conducted by reviewing abstracts and full papers of the available studies, which provided considerable background and promoted knowledge in academic interventional roles in disaster risk management. The articles were searched with a wide range of key words related to the research topic. The studies included the research available between 2000 and September 2017 in the English language. The selection of articles was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.
Of 997 articles, we selected 12 full-text articles that met the criteria for the final review based on the study objective. The results show that, although universities can play multidirectional roles in disaster risk management phases, the development of the academic partnership potential and collaboration for disaster risk management and disaster risk reduction for stakeholders is necessary.
The universities’ potential in providing sufficient disaster health literacy is not currently considered important enough in communities.Therefore, the proper context-bound models of development based on a community’s skills and universities’ potential should receive more attention.
The Comprehensive Framework for Disaster Evaluation Typologies, developed in 2017 (CFDET 2017), aims to unify and facilitate agreement regarding the identification, structure, and relationships between various evaluation typologies found in the disaster setting. A peer-reviewed validation process sought input from international experts in the fields of disaster medicine, disaster/emergency management, humanitarian/development, and evaluation. This paper discusses the validation process, its results, and outcomes.
Previous frameworks, identified in the literature, lack validation and consistent terminology. To gain credibility and utility, this unique framework needed to be validated by international experts in the disaster setting.
A mixed methods approach was designed to validate the framework. An initial iterative process informed an online survey which used a combination of a five-point Likert scale and open-ended questions. Pre-determined consensus thresholds, informed by a targeted literature review, provided the validation criteria.
A sample of 33 experts from 11 countries responded to the validation process. Quantitative measures largely supported the elements and relationships of the framework, and strongly supported its value and usefulness for supporting, promoting, and undertaking evaluations, as well as its usefulness for teaching evaluation in the disaster setting. Qualitative input suggested opportunities to strengthen and enhance the framework. There were limited responses to better understand the barriers and enablers of undertaking disaster evaluations. A potential for self-selection bias of respondents may be a limitation of this study. The attainment of high consensus thresholds, however, provides confidence in the validity of the results.
For the first time, a framework of this nature has undergone a rigorous validation process by experts in three related disciplines at an international level. The modified framework, CFDET 2018, provides a unifying framework within which existing evaluation typologies can be structured. It gives evaluators confidence to choose an appropriate strategy for their particular evaluation in the disaster setting and facilitates consistency in reporting across the different phases of a disaster to better understand the process, outcomes, and impacts of the efficacy and efficiency of interventions. Future research could create a series of toolkits to support improved disaster evaluation processes and to evaluate the utility of the framework in the real-world setting.
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.
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.
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.
This article analyzes the Draft Articles on the Protection of Persons in the Event of Disasters adopted by the International Law Commission in 2016 in light of the recommendation made by the Commission to elaborate a convention on the basis of this project. While the latter proposal is still under evaluation by the United Nations General Assembly, which has recently decided to postpone its decision until 2020, such a potential outcome would represent a significant novelty in the area of disaster law, currently characterized by a fragmented legal framework and the lack of a universal flagship treaty. The Draft Articles thus aim to provide a systematization of the main legal issues relevant in the so-called disaster cycle, with solutions that accommodate the different interests of actors involved in a disaster scenario – namely, the affected State, external assisting actors and disaster victims – using a complex “checks and balances” approach.
Natural disasters have many effects on vulnerable groups, especially infants and children. Protecting breastfeeding in disasters is important, because artificial feeding puts a lot of risk to the child. In disasters, artificial nutrition is dangerous to children and its supplementation requires special equipment. There is little information on the nutritional status of infants after disasters in Iran.
The purpose of this study was to explore the barriers to appropriate lactation after disasters in Iran.
This was a qualitative study using a content analysis method. A total of 19 midwives with disaster-relief experiences were approached for interview. Data were collected using semi-structured interviews. Data analysis was performed using the Graneheim’s approach.
The categories of maternal factors, neonatal factors, management factors, and context-base factors were extracted from the data.
The challenges of social support, mothers’ self-efficacy, educated staff for disasters, and privacy for breastfeeding can be considered as important barriers to breastfeeding in disasters. Training programs, as well as health system support, can help overcome the breastfeeding barriers in disasters.
MirMohamadaliIeM, Khani JazaniR, SohrabizadehS, Nikbakht NasrabadiA. Barriers to Breastfeeding in Disasters in the Context of Iran. Prehosp Disaster Med. 2019;34(1):20–24.