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On August 14, 2017, a 6-kilometer mudslide occurred in Regent Area, Western Area District of Sierra Leone following a torrential downpour that lasted 3 days. More than 300 houses along River Juba were submerged; 1141 people were reported dead or missing and 5905 displaced. In response to the mudslide, the World Health Organization (WHO) Country Office in Sierra Leone moved swiftly to verify the emergency and constitute an incident management team to coordinate the response. Early contact was made with the Ministry of Health and Sanitation and health sector partners. A Public Health Emergency Operations Center was set up to coordinate the response. Joint assessments, planning, and response among health sector partners ensured effectiveness and efficiency. Oral cholera vaccination was administered to high-risk populations to prevent a cholera outbreak. Surveillance for 4 waterborne diseases was enhanced through daily reporting from 9 health facilities serving the affected population. Performance standards from the WHO Emergency Response Framework were used to monitor the emergency response. An assessment of the country’s performance showed that the country’s response was well executed. To improve future response, we recommend enhanced district level preparedness, update of disaster response protocols, and pre-disaster mapping of health sector partners.
To increase knowledge of National Library of Medicine resources by using a train-the-trainer approach.
Workshops were held in spring 2016 to increase knowledge of 4 National Library of Medicine tools. Data were collected before the workshop and immediately, 3 months, and 1 year after the workshop. Knowledge questions were scored as 1 point per question; an aggregated knowledge score could range from 0 to 16 points. A paired t test assessed the change in knowledge from before to after the workshop.
Four workshops were hosted, with a total of 74 attendees. The response rate for the surveys ranged from 50% to 100%. Knowledge scores changed significantly from 7.2 to 11.9 (t = 15, P < .001). One year after the workshop, more of the participants reported having informally trained others (56.8%) than reported providing 1 or more formal training session (8.1%)(P < .001).
Objective measures of knowledge and information dissemination showed that the National Library of Medicine workshop was successful and resulted in both short- and long-term gains. This workshop could be repeated with other populations to further disseminate information regarding the National Library of Medicine tools, which could help improve disaster response.
Communication is essential during public health emergencies and incidents. This research aimed to understand current uses and challenges for public health agencies using social media during these incidents.
An exploratory, qualitative study was conducted using the structured interview matrix facilitation technique. Focus groups were held with professionals from local public health agencies across Ontario, Canada. Representation from different geographic regions was sought to capture differences in participant experience. An inductive approach to content analysis was used to identify emergent themes.
A diverse group of public health professionals (n = 36) participated. Six themes were identified. Social media is identified as a communication tool used to expand reach of messages, to engage in dialogue with the public, and to inform the scope of potential incidents. Barriers to its use include hesitancy to adapt, lack of trust and credibility, and organizational structure and capacity constraints. Key strategies proposed to promote social media use and address barriers resulted from participant discussions and are presented.
Social media use is highly variable across public health agencies in Ontario. This study identifies and provides strategies to address barriers and practice gaps related to public health agencies’ use of social media during emergencies.
Nurses will play a crucial role in responding to a public health emergency resulting from nuclear war or other large-scale release of radiation into the environment and in supporting the National Health Security Strategy. Schools of nursing are ultimately responsible for developing a competent nursing workforce prepared to assess a population’s public health emergency needs and respond to these low-frequency but high-impact events. This responsibility includes the provision of specific content and training regarding how to respond and care for patients and communities in the event of a nuclear or radiation emergency. To date, however, there has been a lack of empirical evidence focusing specifically on nursing schools’ capacity to prepare nurses for radiation emergencies and nuclear events, as well as perception of risk. This study employed a cross-sectional survey administered to a nationwide sample of nursing school administrators and faculty to assess content, faculty expertise, planning, and perception of risk related to radiation emergencies and nuclear events.
Given the frequency of natural hazards in Haiti, disaster risk reduction is crucial. However, evidence suggests that many people exposed to prior disasters do not engage in disaster preparedness, even when they receive training and have adequate resources. This may be partially explained by a link between mental health symptoms and preparedness; however, these components are typically not integrated in intervention.
The current study assesses effectiveness of an integrated mental health and disaster preparedness intervention. This group-based model was tested in three earthquake-exposed and flood-prone communities (N = 480), across three time points, using a randomized controlled trial design. The 3-day community-based intervention was culturally-adapted, facilitated by trained Haitian lay mental health workers, and focused on enhancing disaster preparedness, reducing mental health symptoms, and fostering community cohesion.
Consistent with hypotheses, the intervention increased disaster preparedness, reduced symptoms associated with depression, post-traumatic stress disorder, anxiety, and functional impairment, and increased peer-based help-giving and help-seeking. Mediation models indicated support for the underlying theoretical model, such that the effect of the intervention on preparedness was mediated by mental health, and that effects on mental health were likewise mediated by preparedness.
The community-based mental health-integrated disaster preparedness intervention is effective in improving mental health and preparedness among community members in Haiti vulnerable to natural hazards. This brief intervention has the potential to be scaled up for use with other communities vulnerable to earthquakes, seasonal flooding, and other natural hazards.
Disasters occur rarely but have significant adverse consequences when they do. Recent statistics suggest that millions of lives and billions of US dollars have been lost in the last decade due to disaster events globally. It is crucial that hospitals are well prepared for disasters to minimize their effects. This integrative review study evaluates the preparedness level of hospitals in the Middle East for disasters using the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) guidelines. The key terms include disaster preparedness OR disaster management OR emergency response AND Middle East AND hospitals. The study reviews articles published between January 2005 and December 2015, which focused on the hospitals’ preparedness for disasters in the Middle East nations. Based on their meeting 5 eligibility criteria, 19 articles were included in the review. Twelve of the articles focused on both natural and man-made disasters, whereas 6 of them were based on mass casualty events and 1 on earthquake. Thirteen of the reviewed articles ranked the level of preparedness of hospitals for disasters to be generally “very poor,” “poor,” or “moderate,” whereas 6 reported that hospitals were “well” or “very well prepared” for disasters. Factors affecting preparedness level were identified as a lack of contingency plans and insufficient availability of resources, among others. (Disaster Med Public Health Preparedness. 2019;13:806–816).
Immunization data are vital to support responses to vaccine-preventable disease outbreaks. The Oregon Immunization Program developed a unique prototype instrument—the Rapid Response Tool (RRT)—that provides population data to local responders within 2 hours of a request. Data outputs include vaccination coverage by age group and zip code; percentages of students with nonmedical exemptions to vaccination requirements, by school; and current, comprehensive lists of local vaccination providers.
The RRT was demonstrated to staff at 7 Oregon counties and feedback was solicited via comments and a structured survey.
The RRT received strong support. Attendees identified several uses for RRT data, including outbreak response and ongoing intervention efforts, and they pointed to areas for further development.
The success of the RRT demonstrations illustrates that a well-populated immunization information system can contribute to preparedness work well beyond current standards. (Disaster Med Public Health Preparedness. 2019;13:682–685)
Despite efforts by civil defense authorities, levels of households’ preparedness to emergencies remain insufficient in many countries. Engaging the public in preparedness behavior is a challenge worldwide. The purpose of this study was to explore the efficacy of psychological intervention in promoting preparedness behavior to armed conflicts in Israel.
A randomized controlled trial (N = 381) with two control groups and three intervention groups was used. The psychological interventions studied were elevated threat perception, external reward, and manipulation of a cognitive cluster related to preparedness.
The results of the analysis suggest a significant effect of intervention on the increase of reported preparedness (F4,375 = 4.511, P = 0.001). The effect is attributed to the intervention group in which external reward was offered. Participants in this group were about two times more likely to report greater levels of preparedness compared to the control group (RR = 1.855; 95% CI: 1.065, 3.233).
The findings suggest that preparedness behavior can be promoted through external incentives. These are presumably effective motivators because they encourage preparedness while allowing subjects to retain their denial as an adaptive coping mechanism. Innovative thinking is required to overcome the psychological barriers associated with public reluctance to engage in preparedness. (Disaster Med Public Health Preparedness. 2018;13:713–723)
The Health Belief Model (HBM) can be used as a guide in enhancing the peoples’ awareness, improving the motivation, and providing tools that address beliefs and attitudes toward general disaster preparedness (GDP).
The aim of this study was to improve and re-test all psychometric properties of the published General Disaster Preparedness Belief (GDPB) scale based on HBM carried out in the general population. This scale development study measured by 58 items was prepared under the same structure of the developed GDPB scale that measured 31 items before. This expanded scale was applied to 973 individuals. Firstly, the data from application of the expanded scale was examined under Exploratory Factor Analysis (EFA). Then, the estimations obtained from Confirmatory Factor Analysis (CFA) for the expanded scale with 45 items were compared with the estimations obtained from the previous scale with 31 items.
The EFA lead to the removal of 13 items and the retention of 45 items. The items which the factor loadings were below 0.30 and which gave the factor loadings for more dimension were excluded from the data set. A model measured six dimensions with 45 items was hypothesized: six items under perceived susceptibility, four items under perceived severity, six items under perceived benefits, 14 items under perceived barriers, five items under cues to action, and 10 items under self-efficacy. For CFA results, all estimations for factor loadings were significant. The scale with 45 items obtained in this study fit because Comparative Fit Index (CFI), Goodness of Fit Index (GFI), and Adjusted Goodness of Fit Index (AGFI) were over 0.95.
These results suggest that the scale with 45 items shows improvement in the scale with 31 items. This study indicates that the GDPB scale with 45 items based on HBM has acceptable validity and reliability. This tool can be used in disaster preparedness surveys.InalE, DoganN. Improvement of General Disaster Preparedness Belief Scale Based on Health Belief Model. Prehosp Disaster Med. 2018;33(6):627–636.
Located in the Sunda Megathrust zone, Mentawai Island is known as the epicenter of an active earthquake that has the potential to cause a tsunami. Students would be one of the most vulnerable groups during the disaster.
The low-level of School-Based Disaster Preparedness/Sekolah Siaga Bencana (SSB) of students’ preparedness in disaster risk reduction (DRR) can lead to increased vulnerability of students in facing disaster threats, especially a tsunami.
The study employed observational, correlative analytics with a cross-sectional approach. The sample includes 109 students from fifth and sixth grade in three elementary schools in Sipora, Mentawai Island district.
There was a significant influence between knowledge and attitude towards the preparedness of SSB students in DRR in Sipora, Mentawai Islands district.
Knowledge and attitudes are key factors that must be taken into account in efforts to increase student preparedness to reduce the risk of a tsunami disaster.
Sujarwo, Noorhamdani, Fathoni M. Disaster Risk Reduction in Schools: The Relationship of Knowledge and Attitudes Towards Preparedness from Elementary School Students in School-Based Disaster Preparedness in the Mentawai Islands, Indonesia. Prehosp Disaster Med. 2018;33(6):581–586.
Ultimately, a country’s capacity for a large-scale major emergency response will be directly related to the competence of its health care provider (HCP) workforce and communication between emergency responders and hospitals. The purpose of this study was to assess HCP preparedness and service readiness for a major emergency involving mass casualties (mass casualty event or MCE) in Ireland.
A cross-sectional study using a 53-item survey was administered to a purposive sample of emergency responders and HCPs in the Republic of Ireland. Data collection was achieved using the Qualtrics® Research Suite. Descriptive statistics and appropriate tests of comparison between professional disciplines were conducted using Stata 13.
A total of 385 respondents, registered nurses (43.4%), paramedics (37.9%), medical doctors (10.1%), and administrators/managers (8.6%), participated in the study. In general, a level of knowledge of MCEs and knowledge of clinical response activities and self-assessed clinical competence varied drastically across many aspects of the survey. Knowledge and confidence also varied across professional disciplines (P<0.05) with nurses, in general, reporting the least knowledge and/or confidence.
The results demonstrate that serious deficits exist in HCP knowledge, skills, and self-perceived abilities to participate in a large-scale MCE. Results also suggest a poor knowledge base of existing major emergency response plans. (Disaster Med Public Health Preparedness. 2019;13:243–255)
With an increased number of active shooter events in the United States, emergency departments are challenged to ensure preparedness for these low frequency but high stakes events. Engagement of all emergency department personnel can be very challenging due to a variety of barriers. This article describes the use of an in situ simulation training model as a component of active shooter education in one emergency department. The educational tool was intentionally developed to be multidisciplinary in planning and involvement, to avoid interference with patient care and to be completed in the true footprint of the work space of the participants. Feedback from the participants was overwhelmingly positive both in terms of added value and avoidance of creating secondary emotional or psychological stress. The specific barriers and methods to overcome implementation are outlined. Although the approach was used in only one department, the approach and lessons learned can be applied to other emergency departments in their planning and preparation. (Disaster Med Public Health Preparedness. 2019;13:345–352)
In April 2015, Nepal experienced an earthquake of a magnitude of 7.6 on the Richter scale that resulted in deaths, morbidities, and infrastructure damage. In the post-earthquake period, 4 different workshops and a national “Lessons Learnt” conference were organized to assess the adequacy of the preparedness and response of the health sector. This article summarizes the main conclusions of these discussions relating to leadership, timely search and rescue, referral operations, medical relief to response activities, awareness campaigns, and support from the national and international levels, and epidemiological surveillance. The earthquake response was channeled through rapid response teams that spanned from the community level to the central level via a cluster coordination approach. Overall, the health sector’s response was concluded to be largely satisfactory because it focused not only on emergency medical care, but also on the resumption of basic health services and preventive health care (eg, hygiene, risk communication) equally. Post-disaster disease outbreak did not occur because effective surveillance and outbreak monitoring was one of the priority actions. However, services related to birthing centers, neonatal services, and vaccinations were impeded in some rural areas. Some weaknesses in planning, coordination, and management were also noted. The lessons learned can provide the impetus to strengthen future preparedness and response mechanisms. (Disaster Med Public Health Preparedness. 2018;12:543–547)
Australian undergraduate programmes are implementing curriculum aimed at better preparing graduates to work in Indigenous health settings, but the efficacy of these programmes is largely unknown. To begin to address this, we obtained baseline data upon entry to tertiary education (Time 1) and follow-up data upon completion of an Indigenous studies health unit (Time 2) on student attitudes, preparedness to work in Indigenous health contexts and transformative experiences within the unit. The research involved 336 health science first-year students (273 females, 63 males) who completed anonymous in-class paper questionnaires at both time points. Paired sample t-tests indicated significant change in student attitudes towards Indigenous Australians, perceptions of Indigenous health as a social priority, perceptions of the adequacy of health services for Indigenous Australians and preparedness to work in Indigenous health settings. Hierarchical multiple regression analyses indicated that after controlling for Time 1 measures, the number of precursor steps to transformative learning experienced by students accounted for significant variance in measures of attitudes and preparedness to work in Indigenous health contexts at Time 2. The knowledge gained further informs our understanding of both the transformative impact of such curriculum, and the nature of this transformation in the Indigenous studies health context.
Eight million American children under the age of 5 attend daycare and more than another 50 million American children are in school or daycare settings. Emergency planning requirements for daycare licensing vary by state. Expert opinions were used to create a disaster preparedness video designed for daycare providers to cover a broad spectrum of scenarios.
Various stakeholders (17) devised the outline for an educational pre-disaster video for child daycare providers using the Delphi technique. Fleiss κ values were obtained for consensus data. A 20-minute video was created, addressing the physical, psychological, and legal needs of children during and after a disaster. Viewers completed an anonymous survey to evaluate topic comprehension.
A consensus was attempted on all topics, ranging from elements for inclusion to presentation format. The Fleiss κ value of 0.07 was obtained. Fifty-seven of the total 168 video viewers completed the 10-question survey, with comprehension scores ranging from 72% to 100%.
Evaluation of caregivers that viewed our video supports understanding of video contents. Ultimately, the technique used to create and disseminate the resources may serve as a template for others providing pre-disaster planning education. (Disaster Med Public Health Preparedness. 2019;13:123–127)
This study seeks to determine the capacity of community primary care practices to meet the needs of patients during public health emergencies and to identify the barriers and resources necessary to participate in a coordinated response with public safety agencies.
The self-administered web-based survey was distributed in January 2014 via e-mail to primary care providers in Pennsylvania using the listservs of several professional societies.
A total of 179 primary care providers participated in the survey. In total, 38% had practice continuity of operations plan in place and 26% reported that they had a plan for patient surge in the outpatient setting. Thirty percent reported that they were registered on the state Health Alert Network and 41% said they were able to communicate with patients during disasters. Only 8% of providers reported that they believed that their patients with special health care needs were prepared for a disaster, although over two-thirds of responding practices felt they could assist these patients with disaster preparedness. Providers indicated that more information regarding government agency plans and community resources, patient education materials, and more time to devote to counseling during patient encounters would improve their ability to prepare their patients with special health care needs for disasters. Providers also reported that they would benefit from partnerships to help the practice during emergencies and communications technology to reach large numbers of patients quickly.
Community-based primary care practices can be useful partners during public health emergencies. Efforts to promote continuity of operations planning, improved coordination with government and community partners, as well as preparedness for patients with special health care needs, would augment their capabilities and contribute to community resilience. (Disaster Med Public Health Preparedness. 2019;13:128–132).
We aimed to identify the differences in personal disaster preparedness and disaster risk perception among child care and preschool teachers in South Korea by using demographic characteristics and disaster-related questions.
A cross-sectional self-reporting questionnaire was administered from February to October 2014.
Of all the participants, 68.1% had received disaster preparedness education and training on 2 or more occasions per year; 13.2% had received no education or training. Personal disaster preparedness differed significantly by marital status (P<0.05), the number of disaster education and training sessions attended (P<0.05), and having purchased home insurance (P<0.001). Disaster risk perception differed significantly by children’s age group under a teacher’s care (P<0.05). The topic on which child care teachers wanted more training was “fractures and bleeding emergency care” (53.9%). The most probable disaster was considered to be a typhoon (66.0%).
Disaster preparedness is important for both young children and their teachers. Field-based teacher disaster preparedness education and training should be provided so that they can respond effectively to disaster occurrence regardless of type, time, or location. (Disaster Med Public Health Preparedness. 2018; 12: 321–328)
Noncommunicable diseases (NCDs), including mental disorders, have become major threats to human health worldwide. People with NCDs are particularly vulnerable to disasters. We systematically reviewed reports describing studies of NCDs at the time of the Great East Japan Earthquake (GEJE) to clarify the circumstances of people with NCDs and to build strong measures to support them.
Relevant articles published from March 2011 through December 2016 were collected by searching the PubMed database (National Library of Medicine). We specifically examined reports describing NCDs and including the key words “East Japan Earthquake.” NCDs included every disease type aside from injury and infectious disease.
We collected 160 relevant articles, 41 of which described NCDs that existed in residents before the GEJE. Articles describing respiratory diseases and mental illnesses were found most frequently. Interruption of regular treatment was the most frequent problem, followed by lack of surveillance capacity. We found 101 reports describing NCDs that had developed after the GEJE, of which 60% were related to mental health issues.
NCDs pose major health issues after large-scale disasters. Establishment of strong countermeasures against interruption of treatment and surveillance systems to ascertain medical needs for NCDs are necessary to prepare for future disasters. (Disaster Med Public Health Preparedness. 2018; 12: 396–407)
This study sought to understand facilitators and barriers faced by local US Department of Veterans Affairs Medical Center (VAMC) emergency managers (EMs) when collaborating with non-VA entities.
Twelve EMs participated in semi-structured interviews lasting 60 to 90 minutes discussing their collaboration with non-VAMC organizations. Sections of the interview transcripts concerning facilitators and barriers to collaboration were coded and analyzed. Common themes were organized into 2 categories: (1) internal (ie, factors affecting collaboration from within VAMCs or by VA policy) and (2) external (ie, interagency or interpersonal factors).
Respondents reported a range of facilitators and barriers to collaboration with community-based agencies. Internal factors facilitating collaboration included items such as leadership support. An internal barrier example included lack of clarity surrounding the VAMC’s role in community disaster response. External factors noted as facilitators included a shared goal across organizations while a noted barrier was a perception that potential partners viewed a VAMC partnership with skepticism.
Federal institutions are important partners for the success of community disaster preparedness and response. Understanding the barriers that VAMCs confront, as well as potential facilitators to collaboration, should enhance the development of VAMC–community partnerships and improve community health resilience. (Disaster Med Public Health Preparedness. 2018;12:431–436)
A disaster is a consequence of natural hazards and terrorist acts, which have significant potential to disrupt the entire wireless communication infrastructure. Therefore, the essential rescue squads and recovery operations during a catastrophic event will be severely debilitated. To provide efficient communication services, and to reduce casualty mortality and morbidity during the catastrophic events, we proposed the Tethered Balloon technology for disaster preparedness, detection, mitigation, and recovery assessment.
The proposed Tethered Balloon is applicable to any type of disaster except for storms. The Tethered Balloon is being actively researched and developed as a simple solution to improve the performance of rescues, facilities, and services of emergency medical communication in the disaster area. The most important requirement for rescue and relief teams during or after the disaster is a high quality of service of delivery communication services to save people’s lives.
Using our proposed technology, we report that the Tethered Balloon has a large disaster coverage area. Therefore, the rescue and research teams are given higher priority, and their performance significantly improved in the particular coverage area.
Tethered Balloon features made it suitable for disaster preparedness, mitigation, and recovery. The performance of rescue and relief teams was effective and efficient before and after the disaster as well as can be continued to coordinate the relief teams until disaster recovery. (Disaster Med Public Health Preparedness. 2018;12:222–231)