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Throughout history, earthquakes have caused devastation and loss of life. Emergency medical services (EMS) plays a vital role in the response to any mass-casualty incident or disaster. Magen David Adom, Israel’s premier EMS organization, has a unique strategy known as the ABC approach to earthquake response. It involves thousands of salaried workers and trained volunteers who are prepared to respond to an earthquake based on the extent of the disaster. Depending on the amount of destruction, they will be working locally or available to help in other areas. A Level A earthquake causes local destruction and minimal casualties. Any EMS responders in that area as well as in surrounding areas will be available to help. Furthermore, all responders will need to work automatically and autonomously. A Level B earthquake causes extensive destruction, and all responders in the region will be busy caring for the victims. Anyone available outside of the region will come and help. A Level C earthquake is completely devastating, and all workers nationwide will be involved in responding to the catastrophe. The role of EMS responders using the ABC approach to earthquake response, as described here, may be integrated in part or whole in other EMS systems.
Since its 1960s origins, the Haddon matrix has served as a tool to understand and prevent diverse mechanisms of injuries and promote safety. Potential remains for broadened application and innovation of the matrix for disaster preparedness. Hospital functionality and efficiency are particularly important components of community vulnerability in developed and developing nations alike. Given the Haddon matrixʼs user-friendly approach to integrating current engineering concepts, behavioral sciences, and policy dimensions, we seek to apply it in the context of hospital earthquake preparedness and response. The matrixʼs framework lends itself to interdisciplinary planning and collaboration between social and physical sciences, paving the way for a systems-oriented reduction in vulnerabilities. Here, using an associative approach to integrate seemingly disparate social and physical science disciplines yields innovative insights about hospital disaster preparedness for earthquakes. We illustrate detailed examples of pre-event, event, and post-event engineering, behavioral science, and policy factors that hospital planners should evaluate given the complex nature, rapid onset, and broad variation in impact and outcomes of earthquakes. This novel contextual examination of the Haddon matrix can enhance critical infrastructure disaster preparedness across the epidemiologic triad, by integrating essential principles of behavioral sciences, policy, law, and engineering to earthquake preparedness.
The aim of this study was to explore the mortality pattern due to Gorkha earthquakes in 2015 and review the response and recovery efforts immediately following the earthquakes.
Data from published reports of the Nepal Police showed over 8000 deaths. These death counts were categorized by gender, ethnicity, and age groups (interval of 5 years). The mortality rate was calculated (per 100 000 population), using the projected population as the denominator as of April 2015.
Children < 10 years and older adults > 55 years showed a higher rate of deaths, with similar trends for the most affected districts. Almost 8 more females’ deaths were reported per 100 000 population compared with their male counterparts. There was a higher death rate from Province 3 with a notable gender difference: Nearly 20 more females’ deaths were reported per 100 000 population compared with their male counterparts. There was a higher death rate in mountains (542.4 per 100 000) compared with hills (55.0 per 100 000) and the southern Terai region (0.96 per 100 000) of Nepal.
Young and older adults, female, and residents of remote, mountainous regions of Nepal were vulnerable to the earthquakes. Future earthquake preparedness should focus on the vulnerable population by age and gender and the geographical accessibility.
The Nankai Trough, which marks the boundary between the Eurasian and Philippine Sea plates, is forecasted to create a catastrophic earthquake and tsunami within 30 years. The Japanese government believes that the number of casualties would be huge. However, the exact number of severely injured (SI) people who would need emergency and intensive care has not been identified.
This study, therefore, aimed to clarify the gap between medical supplies and forecasted demand.
The official data estimating the number of injured people were collected, together with the number of intensive care unit (ICU) and high care unit (HCU) beds from each prefecture throughout Japan. The number of SI cases was recalculated based on official data. The number of hospital beds was then compared with the number of SI people.
The total number of hospitals in Japan is 8,493 with 893,970 beds, including 6,556 ICU and 5,248 HCU beds. When the Nankai Trough earthquake occurs, 187 of the 723 disaster base hospitals (DBHs) would be located in the areas with a seismic intensity of an upper six on the Japanese Seismic Intensity Scale (JSIS) of seven, and 79 DBHs would be located in the tsunami inundation area. The estimated total number of injured people would be 661,604, including 26,857 severe, 290,065 moderate, and 344,682 minor cases.
Even if all ICU and HCU beds were available for severe patients, an additional 15,053 beds would be needed. If 80% of beds were used in non-disaster times, the available ICU and HCU beds would be only 2,361. The Cabinet Office of Japan (Chiyoda City, Tokyo, Japan) assumes that 60% of hospital beds would be unavailable in an area with an upper six on the JSIS. The number of ICU and HCU beds that would be usable during a disaster would thus further decrease. The beds needed for severe patients, therefore, would be significantly lacking when the Nankai Trough earthquake occurs. It would be necessary to start the treatment of those severe patients who are “more likely to be saved.”
Health-related quality of life (HQL) among older adults is often neglected and underprioritized in developing countries and is further burdened during natural disasters, such as earthquakes. The main objective of this study was to explore the factors affecting HQL among older adults living in Lalitpur District of Nepal.
A total of 362 older adults participated in this study. Questionnaires were used to interview the respondents on various aspects, such as posttraumatic stress disorder (PTSD) and depression, functional ability, and social support. An analysis was made to explore the factors affecting HQL.
HQL scores ranged between 3.13 and 90.63. A majority of the respondents (215/362; 59.4%) scored ≤ 50, indicating poorer HQL. The multivariate analysis found the impact of the following factors on HQL: functional status (β = 0.295; P < 0.001), PTSD (β = −0.225; P < 0.001), chronic disease (β = −0.168; P < 0.001), social support (β = 0.120; P = 0.019), injury (β = −0.104; P = 0.024), age (β = −0.116; P < 0.001), and accessibility to resources.
Poor HQL of older adults was dependent on various factors. The disaster preparedness program in Nepal needs urgent attention to address the concerns of older adults by incorporating the findings from this study.
Natural disasters are increasing in frequency and impact; they cause widespread disruption and adversity throughout the world. The Canterbury earthquakes of 2010–2011 were devastating for the people of Christchurch, New Zealand. It is important to understand the impact of this disaster on the mental health of children and adolescents.
To report psychiatric medication use for children and adolescents following the Canterbury earthquakes.
Dispensing data from community pharmacies for the medication classes antidepressants, antipsychotics, anxiolytics, sedatives/hypnotics and methylphenidate are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) and nationally. We compared dispensing data for children and adolescents residing in Canterbury DHB with national dispensing data to assess the impact of the Canterbury earthquakes on psychotropic prescribing for children and adolescents.
After longer-term trends and population adjustments are considered, a subtle adverse effect of the Canterbury earthquakes on dispensing of antidepressants was detected. However, the Canterbury earthquakes were not associated with higher dispensing rates for antipsychotics, anxiolytics, sedatives/hypnotics or methylphenidate.
Mental disorders or psychological distress of a sufficient severity to result in treatment of children and adolescents with psychiatric medication were not substantially affected by the Canterbury earthquakes.
In the aftermath of natural disasters and in the urgency of the deteriorating situation in a “complex emergency”, aid is often provided in a haphazard manner. Organizing appropriate medical help is complicated by differences in the type of disaster, the available infrastructure that remains in place, the status of the country’s wealth, and, occasionally, the outbreak of violence and epidemics. Nevertheless, a sequential order of priorities and changing needs for various types of medical intervention such as (emergency) surgery, rehabilitation, and obstetrics can be made, as for managing medicinal needs, mental health, and communicable diseases. This chapter describes how this medical landscape changes qualitatively and quantitatively and how resources can be adapted dynamically and reflected in the capacity of the emergency medical team (EMT). Recently, disaster-prone countries have seen an expansion in the capacity of national EMTs. For a variety of reasons these are to be preferred over international EMTs, but where the latter are needed it is important that their competencies and capabilities follow both local and general guidelines.
The sedimentological and geochemical characteristics of sediments from Lake Szurpiły (northeastern Poland) can be used as a record of mass movement and climate dynamics since the Allerød. Late-glacial sediments suggest enhanced runoff conditions in the catchment after the retreat of the Scandinavian Ice Sheet, while Holocene varved sediments are interrupted by mass-movement deposits (MMDs). We identified 85 thin (<10 cm) MMDs (type 1) that consist of autochthonous material and frequently occur during the Atlantic period. Mobilization of littoral zone and slope sediments caused redeposition in the deepest part of the lake and was likely related to climatic conditions. In contrasting, one sedimentary unit (>1-m-thick MMD type 2) consists of auto- and allochthonous material and represents multistage processes, including erosion and deformation of underlying varved sediments, rapid deposition of clastic material, and redeposition of previously eroded varved sediments. Seismic activity or permafrost degradation was responsible for the deposition of MMD type 2. Furthermore, varve-thickness variability suggests Gleissberg and Suess solar cycles before 850 BC, when human impact was limited. Additionally, 22 and 11 yr sunspot cycles are recognized in light/dark laminae-thickness ratios and reflect influences of solar irradiance on lacustrine productivity.
To describe social participation strategies and resilience in the people affected by the 2017 earthquakes in Mexico.
A cross-sectional study was carried out with 1504 participants from Mexico City, State of Mexico, Oaxaca, Chiapas, Puebla, and Morelos in November and December 2017. A nonprobabilistic convenience sampling method was used to recruit voluntary participants who met the inclusion criteria: age 18 or over and residents in damaged states at the time of the earthquakes. Postearthquake social participation strategies were assessed with the formats used in the postearthquake Chilean survey in 2010. The Spanish-validated version of the resilience scale RS-14 was applied for measuring resilience in the Mexican population.
The most frequent social participation strategies were related to emotional support and aid supplying water, food, and clothing. The highest resilience was observed in the state of Oaxaca and in Mexico City. Men, people age 40 or over, and people who defined themselves as indigenous were the most resilient.
Factors related to resilience were male gender, age over 40, did not participate in activities of help to the community, no household damage, and belonging to an indigenous community.
Focused assessment with sonography for trauma (FAST) has been incorporated into the initial evaluation of trauma for decades. It is an important screening tool in the detection of intra-abdominal fluid. The objective of this study was to perform a systematic review of the use and accuracy of FAST as an imaging tool for blunt abdominal trauma in disaster/mass casualty settings. A systematic review of literature was conducted using key words and search terms. Two independent reviewers screened abstracts to determine inclusion using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). For studies passing QUADAS, a meta-analysis was performed calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). FAST results were compared with the gold standard, which was a combination of CT scan results, operative findings, and medical records of the clinical course. Initial database screening resulted in 133 articles, of which 21 were selected for QUADAS evaluation. Five studies passed QUADAS and were selected in the final meta-analysis, with a total of 4263 patients. The sensitivity of FAST was 92.1% (87.8–95.6), specificity 98.7% (96.0–99.9), PPV 90.7% (70.0–98.0), and NPV 98.8% (98.1–99.5) for the detection of intra-abdominal injury. In our meta-analysis, FAST was both sensitive and specific in the evaluation of trauma in the disaster setting.
Natural disasters, particularly earthquakes, in addition to physical complications, have always had psychological consequences for those affected by them. Stuttering is one of the psychological consequences of shocking events. After a 6.6 magnitude earthquake in Hojedk, Kerman, Iran, two 5-year-old children and a 4-year-old child with symptoms of discontinuous speech (including repeated sound, syllable, and words) were referred to the Kerman Welfare Organization’s rehabilitation center (Kerman, Iran). After history-taking, it became clear that the children had begun to stutter after the earthquake due to fear and stress. Considering the importance of negative emotional experiences in the onset of stuttering, it cannot really be said with certainty that the negative experience of the earthquake initiated the stuttering. Rather, the stuttering had not been present before the earthquake and appeared after the event. These cases indicate the importance of psychosocial support and speech therapy after disasters, especially for children that have higher psychological vulnerability than other age groups.
We analyze the impact of earthquakes on nighttime lights at a sub-national level, i.e., on grids of different size. We argue that existing studies on the impact of natural disasters on economic development have several important limitations, both at the level of the outcome variable as well as at the level of the independent variable, e.g., the timing of an event and the measuring of its intensity. We aim to overcome these limitations by using geophysical event data on earthquakes together with satellite nighttime lights. Using panel fixed effects regressions covering the entire world for the period 1992–2013, we find that earthquakes reduce both light growth rates and light levels significantly. The effects persist for approximately 5 years, but we find no long-run effects. Effects are stronger the smaller the area of a unit of observation. National institutions and economic conditions are relevant moderating factors.
Italy is prone to major earthquakes and has experienced several devastating earthquakes in the far and recent past. The objectives of this study were to assess the level of Italian households’ preparedness for earthquakes and to measure the public’s perception of the risk and its impact on preparedness behavior.
Italian households’ preparedness for earthquakes is insufficient and is influenced by different threat perception components that were assessed.
A cross-sectional study, using an online questionnaire, was conducted in early 2018. The sample included 1,093 responders from a diverse sociodemographic background. The primary outcome was the Preparedness Index (PI), a score indicating the number of preparedness actions complied-with out of 10.
The PI’s mean was 5.26 (SD = 2.17). The recommendation most complied-with was keeping a flashlight at home (87.7%) and the least was securing the kitchen cupboards (15.1%). The PI was positively correlated with a higher sense of preparedness (r = 0.426; P <.001). The PI was higher for responders residing in high-seismic-risk areas and those who experienced a major earthquake before. The predictors of PI were: gender, age, prior experience, sense of preparedness, searching for information, and threat intrusiveness (negatively).
The findings demonstrate a medium-level of preparedness; however, this might be circumstantial. Italians perceive major earthquakes to be unlikely, yet severe if and when they do occur. A validated tool in Italian now exists and can be used in future studies.
Bodas M, Giuliani F, Ripoll-Gallardo A, Caviglia M, Dell’Aringa MF, Linty M, Della Corte F, Ragazzoni L. Threat perception and public preparedness for earthquakes in Italy. Prehosp Disaster Med. 2019;34(2):114–124
Earthquakes may lead to a reaction to severe stress and adjustment disorders (RSSAD). On September 7, 19, and 23, 2017, Mexico was struck by many severe earthquakes. The aim of this study was to examine whether there was an increase in the number of consultations and RSSAD in a psychiatric emergency department in Mexico City after these earthquakes.
We studied retrospectively the diagnosis and triage assessment from a Mexican psychiatric emergency department database from September 1 to November 30, 2017, and analyzed RSSAD and the number of consultations after the earthquakes.
A total of 1,811 psychiatric emergency consultations were registered from the period of study. A total of 141 consultations represented RSSAD. There was a significant increase of RSSAD after the September 23, 2017, earthquake. The triage assessment revealed that the urgency of the consultations was higher immediately after the earthquakes.
Natural disasters, such as earthquakes, may trigger diverse RSSAD leading to increased emergency consultations, especially when those disasters are repetitive. Mental health professionals should be adequately trained and sensitized for possible acute disaster victims. (Disaster Med Public Health Preparedness. 2019;13:686–690).
The aim of this study was to analyze retrospectively the earthquake-induced injuries caused by the October 2015 Hindu Kush earthquake in Pakistan. This is the first population-based study to assess epidemiologically earthquake-induced injuries in the Hindu Kush region, one of the world’s most mountainous and seismically active regions. Unfortunately, only limited studies have investigated the earthquake-induced injuries and deaths in the region epidemiologically.
The 5 worst affected districts were selected according to the highest number of deaths and injuries recorded. A total of 1,790 injuries and 232 deaths were reported after the 2015 earthquake. In our study area, 391 persons were recorded and verified to have been injured as a result of the earthquake. We attempted to investigate all of the 391 injured people, but the final study looked at 346 subjects because the remaining 45 subjects could not be traced because of the non-availability of their complete records and their refusal to participate in the study.
Using the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD 10), we found that the highest number – 20.23% (70 of 346) – of injuries in the earthquake fall in the class of “Injuries to an unspecified part of trunk, limb, or body region (T08-T14).” The class of “Injuries to knee and lower leg (S80-S89),” which count 15.61% (54 out of 346), followed it, and “Injuries involving multiple body regions (T00-T07)” were making 14.74% of total injuries (51 out of 346).
In times of natural disasters like earthquakes, collecting and analyzing real-time data can be challenging. Therefore, a retrospective data analysis of deaths and injuries induced by the earthquake is of high importance. Studies in these emerging domains will be crucial to initiate health policy debates and to prevent and mitigate future injuries and deaths. (Disaster Med Public Health Preparedness. 2018;13:732–739).
The objective of the study was to research the basic seismic response capability (BSRC) of hospitals in Lima Metropolitana. A large number of wounded could be registered in case of an earthquake; therefore, operational hospitals are necessary to cure the injured. The study focused on the operational performance of the hospitals, autonomies of essential resources such as power, water, medical gases, and medicine, in addition to the availability of emergency communication system and ambulances.
Data by a probabilistic seismic risk analysis have been used to assess the operational level of the hospitals. Subsequently, availability of an essential resource has been combined with the immediately operational hospitals to evaluate the BSRC of the health facilities.
Forty-one of Lima’s hospitals have been analyzed for a seismic event with 72-100 years of a return period. Three hospitals (7.3%) were capable to work in a self-sufficient manner for 72 hours, another three (7.3%) for 24 hours, and one (2.4%) for 12 hours.
Results showed a low performance of the hospitals in case of an earthquake. The issue is due to the high seismic vulnerability of the existing structures. Given the importance of Lima city in Peru, structural and nonstructural retrofitting plans should be implemented to improve the preparedness of the health system in case of an emergency. (Disaster Med Public Health Preparedness. 2019;13:138–143)
Shaking and damage in the province of Groningen, the Netherlands, resulting from production-induced seismicity has caused increased public anxiety. Since 2014, production offtake has been reduced stepwise by over 50% in an attempt to minimise production-induced seismicity. The earthquake catalogue, combined with comprehensive data of the changes in production offtake, shows a clear response of seismic activity following the production measures taken. Associated temporal variations in the proportionality between smaller- and larger-magnitude events (the b-value of the Gutenberg–Richter relation) are observed. Since production measures were imposed, the b-value has tended to increase, thus lowering the probability of a larger-magnitude event. The analysis also shows increases in activity rate and b-value prior to larger-magnitude events. Subsequently, the probability of a larger-magnitude event seems to be decreasing prior to the events occurring. This implies that for short-term earthquake prediction of hydrocarbon-production-induced seismicity, these types of analysis could be misleading. However, regional analysis is necessary to explain the observations in terms of rupture initiation. At present, each event felt still draws the interest of both public and press. As some clustering of events in both time and space is still observed, managing both the seismicity and the public perception provides a continuing challenge.
The needs of people with disabilities are not taken into account during disasters, and there is no or little preparation for them. Hence, such people are very anxious about their personal safety during disasters. The aim of this study was to explain the safety needs of people with disabilities during earthquakes.
This qualitative study was conducted with purposive sampling. A total of 12 people with movement disability, aged between 18 and 60 years, and with an experience of facing earthquakes, participated in semi-structured interviews. Thematic analysis was used.
The safety needs of people with disabilities were categorized into three phases: those before an earthquake were considering building codes and resistant construction, building safe and resistant-to-climate-change shelters, and securing the room at the home and workplace; that during an earthquake was the existence of personal protection facilities; and those after an earthquake were adaptation of bathrooms in secure areas, prioritizing conex containers instead of tents, and sheltering in a safe and vermin-free area.
The sudden death of people with disabilities during disasters is preventable through proper planning and preparedness of emergency personnel. Hence, identifying the safety needs of these people and inclusion of such plans in disasters management systems can assure safety for people with disabilities during disasters. (Disaster Med Public Health Preparedness. 2018;12:615–621)
Disasters in countries with limited resources can put the emergency preparedness of the country to the test. The first major task after a disaster is to take care of the wounded. In countries where the epidemiological transition has occurred, chronic disease can place a major strain on public health preparedness after a disaster. The purpose of this field report is to alert public health practitioners of an infrequently reported public health problem: the impact of natural disasters on adherence to chronic medications. In our experience, the most common complaint in the weeks that followed the 2016 earthquake was not having access to their chronic medications. (Disaster Med Public Health Preparedness. 2018; 12: 291–295)
Local health facilities play a critical role in mitigating the deterioration of health after catastrophic disasters. However, limited information is available on clinic damage. Therefore, the National Institute of Public Health conducted surveillance on clinic damage after the 2011 Great East Japan Earthquake (GEJE) to identify risk factors.
A cross-sectional study using a paper-based questionnaire was conducted that targeted 728 clinics located in coastal areas in the 3 prefectures most affected by the GEJE.
The risk of building damage was inversely correlated with distance from the coast, whereas the risk of ceasing operations was significantly correlated with building damage and some specialties of clinics, namely, internal medicine and pediatrics.
In mountainous countries like Japan, clinics often need to be built in coastal areas, where the majority of residents live. This surveillance revealed that clinics built in readily accessible locations and that provide care with high needs are more likely to get damaged by tsunamis. As clinics are often the frontline health facilities in disaster settings, local disaster plans need to include plans to reinforce disaster preparedness among clinics. For effective planning and resource allocation, nationwide hazard vulnerability analysis using a global standard will be helpful. (Disaster Med Public Health Preparedness. 2018; 12: 291–295)