In the 2011 Great East Japan Earthquake, as in Hurricanes Katrina and Rita in the United States, older individuals were at the greatest risk of mortality. Much concern has been raised about developing plans to reduce these risks, but little information has been provided about preparedness, and the key role played by caregivers has been largely unexplored. The aims of this study were thus to examine the preparedness of family caregivers of older adults with long-term care needs and to identify the characteristics of older adults and their caregivers that are associated with poor preparedness and greater concern about disasters.

Shortly after the Great East Japan Earthquake, the second wave of the Fukui Longitudinal Caregiver Study was administered to the family caregivers of older Japanese individuals with long-term care needs. The sample included 952 caregivers from 17 municipalities in Fukui prefecture. Logistic regression analyses were used to identify the factors associated with self-assessed preparedness, evacuation planning, and caregivers’ concerns about preparedness.

The majority (75%) of the caregivers had no concrete plans for evacuation in an emergency, and those caring for persons with dementia were 36% less likely to have any plan. In multivariate models, caregivers who were more experienced and wealthier and who reported more family and community support were more likely to feel well prepared. Caregivers with poor health or limited financial resources or who were responsible for older persons with mobility difficulties reported higher levels of anxiety about their disaster preparedness.

This study indicates that most caregivers are ill prepared to respond in emergencies and that caregiver resources, community support, and the needs of older care recipients influence both preparedness and concern about disasters. Education for caregivers and the development of community support programs could provide important sources of assistance to this vulnerable group. (Disaster Med Public Health Preparedness. 2017;11:31–38)

After large-scale disasters, victim identification frequently presents a challenge and a priority for responders attempting to reunite families and ensure proper identification of deceased persons. The purpose of this investigation was to determine whether currently commercially available facial recognition software can successfully identify disaster victims with facial injuries.

Photos of 106 people were taken before and after application of moulage designed to simulate traumatic facial injuries. These photos as well as photos from volunteers’ personal photo collections were analyzed by using facial recognition software to determine whether this technology could accurately identify a person with facial injuries.

The study results suggest that a responder could expect to get a correct match between submitted photos and photos of injured patients between 39% and 45% of the time and a much higher percentage of correct returns if submitted photos were of optimal quality with percentages correct exceeding 90% in most situations.

The present results suggest that the use of this software would provide significant benefit to responders. Although a correct result was returned only 40% of the time, this would still likely represent a benefit for a responder trying to identify hundreds or thousands of victims. (Disaster Med Public Health Preparedness. 2017;11:568–572)

We sought to better understand the tools used by public health officials in the control of tuberculosis (TB).

We conducted a series of in-depth interviews with public health officials at the local, state, and federal levels to better understand how health departments around the country use isolation measures to control TB.

State and local public health officials’ use of social distancing tools in infection control varies widely, particularly in response to handling noncompliant patients. Judicial and community support, in addition to financial resources, impacted the incentives and enablers used to maintain isolation of infectious TB patients.

Instituting social distancing requires authorities and resources and can be impacted by evidentiary standards, risk assessments, political will, and community support. Awareness of these factors, as well as knowledge of state and local uses of social distancing measures, is essential to understanding what actions are most likely to be instituted during a public health emergency and to target interventions to better prepare health departments to utilize the best available tools necessary to control the spread of disease. (Disaster Med Public Health Preparedness. 2017;11:337–342)

Health care workers are critical first responders. Understanding which factors motivate their willingness to work (WTW) during infectious disease outbreaks may guide improvements in preparedness. The perspective of health care students, the future workforce, remains largely unexplored. This study compared factors influencing WTW among medical, nursing, and pharmacy students.

A printed survey was administered to 631 medical, nursing, and pharmacy students. The questionnaire elicited information regarding prior disaster training, disease-related knowledge, and WTW in the setting of infectious diseases with contact or respiratory transmission.

Analyses of the 579 respondents (92% response rate) demonstrated that students were less fearful for their health and more willing to work during outbreaks with contact transmission than during those with respiratory transmission. Medical students were the most fearful for their health, but they demonstrated the greatest WTW, followed by nursing students, and then pharmacy students. Medical students were also the most knowledgeable about infectious diseases. Prior disaster training was associated with greater WTW.

Extent of disease-related knowledge and prior disaster training appear to influence WTW. Our findings, taken in the context of a remarkable underemphasis on disaster preparedness in health care curricula, call for a broader incorporation of disaster training to improve the WTW of health care students, and, ultimately, health care workers. (Disaster Med Public Health Preparedness. 2017;11:694–700)

The aim of this study was to investigate the prevalence of post-traumatic stress disorder (PTSD) and its association with each traumatic experience among 5- to 8-year-old children 2 years after the Great East Japan Earthquake.

Children ages 5-8 years who were in selected preschool classes on March 11, 2011, in 3 prefectures affected by the earthquake and 1 prefecture that was unaffected, participated in the study (N=280). PTSD symptoms were assessed through questionnaires completed by caregivers and interviews by psychiatrists or psychologists conducted between September 2012 and May 2013 (ie, 1.5-2 years after the earthquake).

Among children who experienced the earthquake, 33.8% exhibited PTSD symptoms. Of the different traumatic experiences, experiencing the earthquake and the loss of distant relatives or friends were independently associated with PTSD symptoms; prevalence ratios: 6.88 (95% confidence interval [CI]: 2.06-23.0) and 2.48 (95% CI: 1.21-5.08), respectively.

Approximately 1 in 3 young children in the affected communities exhibited PTSD symptoms, even 2 years after the Great East Japan Earthquake. These data may be useful for preventing PTSD symptoms after natural disasters and suggest the importance of providing appropriate mental health services for children. (Disaster Med Public Health Preparedness. 2017;11:207–215)

We evaluated the usefulness and accuracy of media-reported data for active disaster-related mortality surveillance.

From October 29 through November 5, 2012, epidemiologists from the Centers for Disease Control and Prevention (CDC) tracked online media reports for Hurricane Sandy–related deaths by use of a keyword search. To evaluate the media-reported data, vital statistics records of Sandy-related deaths were compared to corresponding media-reported deaths and assessed for percentage match. Sensitivity, positive predictive value (PPV), and timeliness of the media reports for detecting Sandy-related deaths were calculated.

Ninety-nine media-reported deaths were identified and compared with the 90 vital statistics death records sent to the CDC by New York City (NYC) and the 5 states that agreed to participate in this study. Seventy-five (76%) of the media reports matched with vital statistics records. Only NYC was able to actively track Sandy-related deaths during the event. Moderate sensitivity (83%) and PPV (83%) were calculated for the matching media-reported deaths for NYC.

During Hurricane Sandy, the media-reported information was moderately sensitive, and percentage match with vital statistics records was also moderate. The results indicate that online media-reported deaths can be useful as a supplemental source of information for situational awareness and immediate public health decision-making during the initial response stage of a disaster. (Disaster Med Public Health Preparedness. 2017;11:460–466)

Our study of informal networks aimed to explore information-sharing environments for the management of disaster medicine and public health preparedness. Understanding interagency coordination in preparing for and responding to extreme events such as disease outbreaks is central to reducing risks and coordination costs.

We evaluated the pattern of information flow for actors involved in disaster medicine through social network analysis. Social network analysis of agencies can serve as a basis for the effective design and reconstruction of disaster medicine response coordination structures. This research used new theoretical approaches in suggesting a framework and a method to study the outcome of complex inter-organizational networks in coordinating disease outbreak response. We present research surveys of 70 health professionals from different skill sets and organizational positions during the swine influenza A (H1N1) PDM09 2009 pandemic. The survey and interviews were designed to collect both qualitative and quantitative data in order to build a comprehensive and in-depth understanding of the dynamics of the inter-organizational networks that evolved during the pandemic.

The degree centrality of the informal network showed a positive correlation with performance, in which the ego’s performance is related to the number of links he or she establishes informally—outside the standard operating structure during the pandemic. Informal networks facilitate the transmission of both strong (ie, infections, confirmed cases, deaths in hospital or clinic settings) and weak (ie, casual acquaintances) ties.

The results showed that informal networks promoted community-based ad hoc and formal networks, thus making overall disaster medicine and public health preparedness more effective. (Disaster Med Public Health Preparedness. 2017;11:343–354)

Cooling devices (CDs) worn under personal protective equipment (PPE) can alleviate some of the heat stress faced by health care workers responding to the Ebola outbreak in West Africa.

Six healthy, young individuals were tested while wearing 4 different CDs or no cooling (control) under PPE in an environmental chamber (32°C/92% relative humidity) while walking (3 METs, 2.5 mph, 0% grade) on a treadmill for 60 minutes. Exercise was preceded by a 15-minute stabilization period and a 15-minute donning period.

The control condition resulted in a significantly higher rectal temperature (Tre) at the end of the exercise than did all CD conditions (CD1, P=0.004; CD2, P=0.01; CD3, P=0.000; CD4, P=0.000) with CD1 and CD2 resulting in a higher Tre than CD3 and CD4 (P<0.05). The control condition resulted in a higher heart rate (HR) at the end of exercise than did the CD3 (P=0.01) and CD4 (P=0.009) conditions, whereas the HR of the CD1 and CD2 conditions was higher than that of the CD3 and CD4 conditions (P<0.05). Weight loss in the control condition was higher than in the CD3 (P=0.003) and CD4 (P=0.01) conditions. Significant differences in subjective measurements of thermal stress were found across conditions and time.

Use of CDs can be advantageous in decreasing the negative physiological and subjective responses to the heat stress encountered by health care workers wearing PPE in hot and humid environments. (Disaster Med Public Health Preparedness. 2017;11:573–579)

This study aimed to compare the physical activity level and health-related quality of life (HRQOL) between older survivors residing in temporary housing after the Great East Japan Earthquake (GEJE; temporary housing group) and older individuals residing in their own homes (control group) and to clarify whether mobility function and muscle strength were correlated with physical activity among older temporary housing residents.

Subjects were recruited to the temporary housing group (n=64, 19 men and 45 women) or control group (n=64, 33 men and 31 women) according to their residence. Physical activity was assessed by the number of walking steps determined by using a triaxial accelerometer, mobility function by the Timed Up and Go test, muscle strength by the grasping power test, and HRQOL by the Medical Outcome Study 36-Item Short Form Survey v2.

In the temporary housing group, reduced physical activity and correlation between physical activity and mobility function in men, and muscle strength in both men and women, were observed. There was no significant difference in HRQOL between groups except for bodily pain in women.

Support for older evacuees should focus on maintaining their physical activity level as well as on HRQOL to avoid deterioration of health in these survivors. (Disaster Med Public Health Preparedness. 2017;11:701–710)

This study aimed to clarify the correlation between the 2011 Great East Japan Earthquake and domestic violence (DV) against pregnant females after the disaster in Miyagi Prefecture, an area damaged by the earthquake and tsunami.

We analyzed 7600 pregnant females from June to December 2011. The incidence of physical and mental DV and the proportions in the inland, north coastal, and south coastal areas of Miyagi Prefecture and nationwide were calculated, and a chi-square test was conducted for comparison. The risk factors for DV were estimated with multivariate logistic regression analyses on a prefecture-wide basis.

The incidence levels for physical DV were found to be 5.9% in the north coastal area, which was significantly higher than in the inland area (1.3%, P=0.0007) and nationwide (1.5%, P<0.0001). There were no significant differences in the incidence of mental DV between the 3 areas in Miyagi Prefecture (inland 15.2%, north coast 15.7%, and south coast 18.8%) or nationwide (13.8%). Experiencing disease or injury in someone close and changes in the family structure were significantly associated with mental DV in Miyagi Prefecture.

Continuous monitoring and support for pregnant females may be necessary to address this issue in disaster-affected areas. (Disaster Med Public Health Preparedness. 2017;11:216–226)

To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency.

A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators.

In the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster.

The identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467–472)

Individuals exposed to natural disasters are at risk for negative physical and psychological outcomes. Older adults may be particularly vulnerable; however, social support can act as a resource to help individuals respond to severe stressors. This study explored the challenges older people faced before, during, and after Hurricane Sandy in October 2012 and the people they turned to for support.

Semi-structured interviews were conducted with 20 older adults in New Jersey drawn from the ORANJ BOWL (Ongoing Research on Aging in New Jersey – Bettering Opportunities for Wellness in Life) research panel, who experienced high levels of primary home damage during Hurricane Sandy. Content analysis of interview transcripts classified older adults’ perceptions on how they “made it” through—the challenges they faced and the support they received.

The findings suggested that older adults experienced emotional, instrumental, social, and financial challenges before, during, and after the storm. However, by relying on family and friends, as well as neighbors and community networks, older people were able to respond to stressors.

Our findings carry implications for ensuring that older adults are connected to social networks before, during, and after disasters. The role of neighbors is particularly important when disasters strike. (Disaster Med Public Health Preparedness. 2017;11:39–47)

Elderly individuals are considered at elevated risk of disaster impacts owing to increased health concerns, reduced mobility, and fixed economic resources. Social capital can counteract these vulnerabilities by increasing the likelihood of hearing disaster warnings, providing social ties to assist with preparation and evacuation, and providing access to financial or nonfinancial resources. I aimed to analyze the relationship between age and perceptions of disaster-related social capital.

I used mailed surveys and in-person interviews with a sample of residents from 2 Florida counties to study perceptions of social capital available for disaster.

The results showed that age has a negative effect on perceptions of social capital resources available during a disaster. The elderly reported fewer social ties overall and much fewer social ties that could provide financial assistance, if necessary, during a disaster.

These results indicate that social capital may not counteract the social vulnerabilities of elderly persons to disaster impacts. (Disaster Med Public Health Preparedness. 2017;11:48–55)

We aimed to clarify the correlation between the 2011 Great East Japan Earthquake and pregnant women’s awareness of social capital 3 to 9 months after the tsunami disaster.

We analyzed data on responses to a questionnaire by 7451 pregnant women in their second to third trimesters. The proportions of social capital–related items were calculated in the north and south coastal areas of Miyagi Prefecture and were compared with national samples. The factors associated with social capital were estimated by use of multivariate logistic regression analyses.

The proportion of women feeling that they had helpful neighbors was higher (69.0% vs 56.7%, P=0.0005), the proportion of women regarding their communities as safe and secure was lower (51.7% vs 62.4%, P=0.002), and the proportion of women feeling that most people were trustworthy was lower (23.7% vs 32.9%, P=0.006) in the north coastal area than nationwide. Such differences were not observed in the less severely affected south coastal area. Age of 35 years or older, extended family, college or university graduation, and being multiparous were associated with the feeling of having helpful neighbors.

The current status of pregnant women’s awareness of social capital in disaster-affected areas was revealed. Continuous monitoring and support may be necessary to address this issue.(Disaster Med Public Health Preparedness. 2017;11:355–364)

Personal protective equipment (PPE) provides health care workers with a barrier to prevent human contact with viruses like Ebola and potential transmission of the disease. However, PPE can also introduce an additional physiological burden from potentially increased heat stress. This study evaluated the human physiological and subjective responses to continuous light exercise within environmental conditions similar to those in West Africa while wearing 3 different, commonly used PPE ensembles (E1, E2, and E3).

Six healthy individuals were tested in an environmental chamber (32°C, 92% relative humidity) while walking (3 METs, 2.5 mph, 0% incline) on a treadmill for 60 minutes. All subjects wore medical scrubs and PPE items. E1 also had a face shield and fluid-resistant surgical gown; E2 additionally included goggles, coverall, and separate hood; and E3 also contained a highly impermeable coverall, separate hood, and surgical mask cover over the N95 respirator.

Heart rate and core temperature at the end of the exercise were significantly higher for E2 and E3 than for E1. Subjective perceptions of heat and exertion were significantly higher for E2 and E3 than for E1.

Heat stress and PPE training, as well as the implementation of a work-to-rest ratio that avoids dehydration and possible heat stress issues, are recommended. (Disaster Med Public Health Preparedness. 2017;11:580–586)

The US federal government invests in the development of medical countermeasures for addressing adverse health effects to the civilian population from chemical, biological, and radiological or nuclear threats. We model the potential economic spillover effects in day-to-day burn care for a federal investment in a burn debridement product for responding to an improvised nuclear device.

We identify and assess 4 primary components for projecting the potential economic spillover benefits of a burn debridement product: (1) market size, (2) clinical effectiveness and cost-effectiveness, (3) product cost, and (4) market adoption rates. Primary data sources were the American Burn Association’s 2015 National Burn Repository Annual Report of Data and published clinical studies used to gain European approval for the burn debridement product.

The study results showed that if approved for use in the United States, the burn debridement product has potential economic spillover benefits exceeding the federal government’s initial investment of $24 million a few years after introduction into the burn care market.

Economic spillover analyses can help to inform the prioritizing of scarce resources for research and development of medical countermeasures by the federal government. Future federal medical countermeasure research and development investments could incorporate economic spillover analysis to assess investment options. (Disaster Med Public Health Preparedness. 2017;11:711–719)

The objective of this study was to quantify the potential retail pharmacy vaccine administration capacity and its possible impact on pandemic influenza vaccine uptake.

We developed a discrete event simulation model by use of ExtendSim software (Imagine That Inc, San Jose, CA) to forecast the potential effect of retail pharmacy vaccine administration on total weekly vaccine administration and the time needed to reach 80% vaccination coverage with a single dose of vaccine per person.

Results showed that weekly national vaccine administration capacity increased to 25 million doses per week when retail pharmacist vaccination capacity was included in the model. In addition, the time to achieve 80% vaccination coverage nationally was reduced by 7 weeks, assuming high public demand for vaccination. The results for individual states varied considerably, but in 48 states the inclusion of pharmacies improved time to 80% coverage.

Pharmacists can increase the numbers of pandemic influenza vaccine doses administered and reduce the time to achieve 80% single-dose coverage. These results support efforts to ensure pharmacist vaccinators are integrated into pandemic vaccine response planning. (Disaster Med Public Health Preparedness. 2017;11:587–593)

Our institution relocated to a new facility 3.5 miles from our original location in Chicago on June 9, 2012. We describe the tools we developed to prepare, execute, and manage our evacuation and relocation.

Tools developed for the planned evacuation included the following: level of acuity and team composition classification, patient departure checklist, evacuation handoff tool, and a patient tracking system within the electronic health record. Incident Command structure was utilized.

Monthly census tracking exercises were held beginning 12 months before the evacuation. Simulation drills began 6 months before the evacuation. The entire evacuation took less than 14 hours and there were no safety issues. A total of 127 patients were transported to the new facility: 45 patients were moved via the Neonatal/Pediatric Critical Care Transport Team, and the rest were moved with various team configurations.

Documents developed for a planned evacuation can be used for any planned or unplanned evacuation. We believe the tools we used to prepare, execute, and manage our evacuation and relocation would assist any health care facility to be better prepared to safely and efficiently evacuate patients in the event of a disaster, or to create surge capacity, and relocate them to another facility. (Disaster Med Public Health Preparedness. 2017;11:479–486)