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Research on disaster behavioral health presents significant methodological challenges. Challenges are even more complex for research on mass violence events that involve military members, families, and communities, due to the cultural and logistical considerations of working with this population. The current article aims to inform and educate on this specialized area of research, by presenting a case study on the experience of designing and conducting disaster behavioral health research after a mass violence event in a military setting: the 2013 mass shooting at the Washington Navy Yard, in Washington, D.C. Using the case example, the authors explore methodological challenges and lessons learned from conducting research in this context, and provide guidance for future researchers.
Heavy rains in March 2019 led to severe floods in large parts of Iran, with severe financial and physical casualties (in the Golestan province, 11 districts were trapped in water). An increase in the EMS missions while serving a big portion of the needed population was a big problem for the health system during the flood; Therefore, a new solution was needed to overcome this problem. Using a farm tractor for transporting the patients and injured people was the first relief experience ever documented in the whole country. In the present report, despite the limitations and challenges, the tractor has been shown to be a proper and effective disaster relief vehicle. This report could help other similar countries face disasters, especially floods.
Hurricane evacuation is one of the strategies employed by emergency management and other agencies to reduce morbidity and mortality associated with hurricanes. However, factors associated with residents’ evacuation decision-making have been inconsistent. In this study, we conducted a statistical meta-analysis to identify factors associated with hurricane evacuation as well as moderators of the evacuation decision.
A systematic literature search identified 36 studies published between 1999 and 2018. Pooled estimates were calculated using random-effects models, and heterogeneity across studies was checked using both Q and I2 statistics. Meta-regression methods were used to identify moderators. Publication bias was assessed using both visual (funnel plots) and statistical methods.
Mobile home residence, perception of risk, female sex, and Hispanic ethnicity were statistically associated with hurricane evacuation, while geographic region modified the relationship between Hispanic race and evacuation.
Agencies responsible for preparedness may utilize these findings to identify specific population sub-groups for hurricane evacuation communication and other interventions. Future studies should consider statistical interactions and explore opportunities for research translation to emergency officials.
Individuals present in lower Manhattan during the 9/11 World Trade Center (WTC) disaster suffered from significant physical and psychological trauma. Studies of longitudinal psychological distress among those exposed to trauma have been limited to relatively short durations of follow-up among smaller samples.
The current study longitudinally assessed heterogeneity in trajectories of psychological distress among WTC Health Registry enrollees – a prospective cohort health study of responders, students, employees, passersby, and residents in the affected area (N = 30 839) – throughout a 15-year period following the WTC disaster. Rescue/recovery status and exposure to traumatic events of 9/11, as well as sociodemographic factors and health status, were assessed as risk factors for trajectories of psychological distress.
Five psychological distress trajectory groups were found: none-stable, low-stable, moderate-increasing, moderate-decreasing, and high-stable. Of the study sample, 78.2% were classified as belonging to the none-stable or low-stable groups. Female sex, being younger at the time of 9/11, lower education and income were associated with a higher probability of being in a greater distress trajectory group relative to the none-stable group. Greater exposure to traumatic events of 9/11 was associated with a higher probability of a greater distress trajectory, and community members (passerby, residents, and employees) were more likely to be in greater distress trajectory groups – especially in the moderate-increasing [odds ratios (OR) 2.31 (1.97–2.72)] and high-stable groups [OR 2.37 (1.81–3.09)] – compared to the none-stable group.
The current study illustrated the heterogeneity in psychological distress trajectories following the 9/11 WTC disaster, and identified potential avenues for intervention in future disasters.
To evaluate food and water storage practices in the United States, including the extent that government emergency preparedness guidelines were followed.
Qualtrics panelists (n = 572) completed a 142-item online survey in August 2014. Cognitive interviews (n = 5) and pilot data (n = 14) informed survey development. Descriptive statistics were used to analyze quantitative data. Open-ended responses related to water storage preparation were classified into 5 categories.
Many respondents reported being somewhat or well prepared to provide food and water for their households during a large-scale disaster or emergency. Only 53% met Federal Emergency Management Agency (FEMA) guidelines to have water last at least 3 days. Based on respondents’ self-report, it appeared that those who prepared personally-filled containers for water did not carefully follow FEMA instructions. Most respondents had non-perishable foods available, with 96% meeting the FEMA guidelines of at least 3 days of storage.
Households were generally prepared to provide food and, to a lesser extent, water in emergency situations, but were not consistently following FEMA guidelines. Additional easy-to-follow, evidence-based information may better help citizens accurately implement food and water storage emergency preparedness guidelines.
Respiratory transmission, especially in mass gatherings, is considered one of the main ways of influenza transmission. The Hajj ceremony, as one of the largest gatherings worldwide, can increase the distribution of influenza infection. Thus, the present study aimed to evaluate the incidence of influenza among Hajj pilgrims.
In this present systematic review and meta-analysis, all English studies published by 2019 were extracted from several databases such as the Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, and Google Scholar. Finally, the data were extracted using a pre-prepared checklist and then analyzed by fixed and random effects model tests in the meta-analysis, Cochran, meta-regression, and Begg’s test.
Eighteen studies with a sample size of 62 431 were entered into the meta-analysis process. The overall prevalence of influenza, in addition to the prevalence of types A, B, and C influenza, was estimated at 5.9 (95% CI: 4.3-8.0), 3.6 (95% CI: 2.6-4.9), 2.9 (95% CI: 2.8-3.1), and 0.9% (95% CI: 0.5-1.5), respectively.
In general, influenza remains widespread regardless of vaccinating pilgrims and following health protocols. Therefore, it is recommended that comprehensive management and educational approaches be used to reduce the prevalence of influenza and its adverse consequences among the pilgrims.
To assess non-pediatric nurses’ willingness to provide care to pediatric patients during a mass casualty event (MCE).
Nurses from 4 non-pediatric hospitals in a major metropolitan Midwestern region were surveyed in the fall of 2018. Participants were asked about their willingness to provide MCE pediatric care. Hierarchical logistical regression was used to describe factors associated with nurses’ willingness to provide MCE pediatric care.
In total, 313 nurses were approached and 289 completed a survey (response rate = 92%). A quarter (25.3%, n = 73) would be willing to provide MCE care to a child of any age; 12% (n = 35) would provide care only to newborns in the labor and delivery area, and 16.6% (n = 48) would only provide care to adults. Predictors of willingness to provide care to a patient of any age during an MCE included providing care to the youngest-age children during routine duties, reporting confidence in calculating doses and administering pediatric medications, working in the emergency department, being currently or previously certified in PALS, and having access to pediatric-sized equipment in the unit or hospital.
Pediatric surge capacity is lacking among nurses. Increasing nurses’ pediatric care self-efficacy could improve pediatric surge capacity and minimize morbidity and mortality during MCEs.
Community characteristics, such as collective efficacy, a measure of community strength, can affect behavioral responses following disasters. We measured collective efficacy 1 month before multiple hurricanes in 2005, and assessed its association to preparedness 9 months following the hurricane season.
Participants were 631 Florida Department of Health workers who responded to multiple hurricanes in 2004 and 2005. They completed questionnaires that were distributed electronically approximately 1 month before (6.2005-T1) and 9 months after (6.2006-T2) several storms over the 2005 hurricane season. Collective efficacy, preparedness behaviors, and socio-demographics were assessed at T1, and preparedness behaviors and hurricane-related characteristics (injury, community-related damage) were assessed at T2. Participant ages ranged from 21-72 (M(SD) = 48.50 (10.15)), and the majority were female (78%).
In linear regression models, univariate analyses indicated that being older (B = 0.01, SE = 0.003, P < 0.001), White (B = 0.22, SE = 0.08, P < 0.01), and married (B = 0.05, SE = 0.02, p < 0.001) was associated with preparedness following the 2005 hurricanes. Multivariate analyses, adjusting for socio-demographics, preparedness (T1), and hurricane-related characteristics (T2), found that higher collective efficacy (T1) was associated with preparedness after the hurricanes (B = 0.10, SE = 0.03, P < 0.01; and B = 0.47, SE = 0.04, P < 0.001 respectively).
Programs enhancing collective efficacy may be a significant part of prevention practices and promote preparedness efforts before disasters.
Disasters have many deleterious effects and are becoming more frequent. From a health-care perspective, disasters may cause periods of stress for hospitals and health-care systems. Telemedicine is a rapidly growing technology that has been used to improve access to health-care during disasters. Telemedicine applied in disasters is referred to as disaster telemedicine. Our objective was to conduct a scoping literature review on current use of disaster telemedicine to develop recommendations addressing the most common barriers to implementation of a telemedicine system for regional disaster health response in the United States. Publications on telemedicine in disasters were collected from online databases. This included both publications in English and those translated into English. Predesigned inclusion/exclusion criteria and a PRISMA flow diagram were applied. The PRISMA flow diagram was used on the basis that it would help streamline the available literature. Literature that met the criteria was scored by 2 reviewers who rated relevance to commonly identified disaster telemedicine implementation barriers, as well as how disaster telemedicine systems were implemented. We also identified other frequently mentioned themes and briefly summarized recommendations for those topics. Literature scoring resulted in the following topics: telemedicine usage (42 publications), system design and operating models (43 publications), as well as difficulties with credentialing (5 publications), licensure (6 publications), liability (4 publications), reimbursement (5 publications), and technology (24 publications). Recommendations from each category were qualitatively summarized.
As rising seas, spreading wildfires, and unbearable heat shrink the expanse of the habitable earth, the prospect of a contracting world resonates in particular and forceful ways within the American imaginary. Recent American climate fiction responds to the specter of a shrinking world by reprising narratives of the American frontier, simultaneously unsettling and reanimating elements of these stories. This chapter pays attention to stories of neo-agrarian settlements, depictions of internal displacements and migrations, and portrayals of corporate collapse in the wake of dwindling carbon economies. It argues that American climate fiction can run retrograde, reiterating the very seizures of land and political suppressions that underwrote the American frontier. However, the radical environmental changes envisioned in this genre also intensify ongoing struggles for racial and economic justice in the United States, opening the possibility of more equitable forms of relation. Although the climatic future is often depicted as a brave new world, an unknown terrain, climate narratives must acknowledge rather than subsume history: A changed world must not be mistaken for a wholly new one.
Exceptional children, like other children, have the right to be educated in a safe environment. Disasters are considered as serious issues regarding safety and security of educational environments. Following disasters, vulnerable groups, especially children with handicaps and disabilities are more likely to be seriously injured. Thus, the present study aimed to evaluate the safety and disaster risk assessment of exceptional schools in Tehran, Iran.
The cross-sectional study was conducted in exceptional schools in Tehran, 2018. First, 55 exceptional schools in all grades were selected based on census sampling method and evaluated by using a checklist designed by Tehran Disaster Mitigation and Management Organization (TDMMO) and Ministry of Education in 2015. The data were analyzed using Excel software and statistical descriptive tests.
Based on the results, school facilities are worn and have unsafe elevators (least safety: 7.69%), yards (least safety: 9.52%), laboratories (least safety: 16.67%), libraries (least safety: 24.24%), fire extinguishing systems (least safety: 28.99%), and storage rooms and kitchens (least safety: 33.33%) which require immediate considerations. In total, the safety of exceptional schools in this study was 70.13%, which suggests medium-risk level.
The educational settings must be reconsidered, along with identifying the risk and safety at school. In addition, a standard should be established for evaluating safety, especially in exceptional schools.
What, if anything, is wrong with price gouging? Its defenders argue that it increases supply of scarce necessities; critics argue that it is exploitative, inequitable and vicious. In this paper, I argue for its moral wrongness and legal prohibition, without relying on charges of exploitation, inequity or poor character. What is fundamentally wrong with price gouging is that it violates a duty of easy rescue. While legal enforcement of such duties is controversial, a special case can be made for their legal enforcement in this context. This account distinguishes, morally, price gouging by corporations from that of individual entrepreneurs.
Dezful is the capital of Dezful County, a city in Khuzestan Province, Iran. On August 12, 2017, after a chlorine gas leakage in Dezful, more than 475 people were affected by chlorine gas, and they all suffered from respiratory complications. A lot of problems were encountered in the preparation of the relief forces and organization of the blueprint on how to respond to the incident, such as lack of knowledge on establishment of danger zone, lack of warning system, lack of proper triage and absence of decontamination plans, lack of special chemical safety outfit and respiratory equipment for rescuers, lack of instructions for proper handling, lack of knowledge in dealing with this type of disaster, and inappropriate evacuation skills and failure to cordon off and insure the location of the incident. Although the initial measures to arrest this crisis was performed based on the health system’s instructions of the country with regard to all the possible risks, lack of a comprehensive inter-organizational program and prevention plans, lack of control plans, lack of adequate preparation and response to chemical poisoning, lack of foresight, lack of a risk plan, and lack of an intervention plan for these incidents were the reasons for the damages and problems encountered after the crisis.
Understanding the drivers of health care utilization patterns following disasters can better support health planning. This study characterized all-cause hospitalizations among older Americans after eight large-scale hurricanes.
The objective of this study was to characterize all-cause hospitalizations for any cause among older Americans in the 30 days after eight large-scale hurricanes.
A self-controlled case series study among Medicare beneficiaries (age 65+) exposed to one of eight hurricanes was conducted. The predicted probability of sociodemographic factors associated with hospitalization using logit models was estimated.
Hurricane Sandy (2012) had the highest post-hurricane admission rate, a 23% increase (incidence rate ratio [IRR] = 1.23; 95% CI, 1.22-1.24), while Hurricane Irene in 2011 had only a 10% increase (IRR = 1.10; 95% CI, 1.09-1.11). Higher likelihood of hospitalization occurring after hurricanes included being 85 or older (36.8% probability of hospitalization; 95% CI, 34.7-39.0) and being dually eligible for Medicare and Medicaid (62.8%; 95% CI, 60.7-64.9).
Planning to address the surge in hospitalization for a longer time period after hurricanes and interventions targeted to support aging Americans are needed.
This study evaluates the effectiveness of our game-based pedagogical technique by comparing the learning, enjoyment, interest, and motivation of medical students who learned about best practices for patient surge in a natural disaster with a novel game-based computer application, with those of medical students who learned about it with a traditional lecture.
We conducted our study by modifying an existing optional course in disaster medicine that we taught at Sichuan University. More specifically, in 2017, while our application was still in development, we taught this course by lecture. In this iteration, 63 third-grade medical students voluntarily joined our course as our ‘lecture group.’ Once our application was complete in 2018, 68 third-grade medical students voluntarily joined this course as the ‘game group.’ We examined the different effects of these learning methods on student achievement using pre -, post -, and final tests.
Both teaching methods significantly increased short-term knowledge and there was no statistical difference between the 2 methods (p > 0.05). However, the game group demonstrated significantly higher knowledge retention than the traditional lecture group (p < 0.05).
Our game-based computer application proved to be an effective tool for teaching medical students best practices for caring for patient surge in a natural disaster.
Coronavirus disease (COVID-19) is a “disaster of uncertainty” with ambiguity about its nature and trajectory. These features amplify its psychological toxicity and increase the number of psychological casualties it inflicts. Uncertainty was fueled by lack of knowledge about the lethality of a disaster, its duration, and ambiguity in messaging from leaders and health care authorities. Human resilience can have a buffering effect on the psychological impact. Experts have advocated “flattening the curve” to slow the spread of the infection. Our strategy for crisis leadership is focused on flattening the rise in psychological casualties by increasing resilience among health care workers. This paper describes an approach employed at Johns Hopkins to promote and enhance crisis leadership. The approach is based on 4 factors: vision for the future, decisiveness, effective communication, and following a moral compass. We make specific actionable recommendations for implementing these factors that are being disseminated to frontline leaders and managers. The COVID-19 pandemic is destined to have a strong psychological impact that extends far beyond the end of quarantine. Following these guidelines has the potential to build resilience and thus reduce the number of psychological casualties and speed the return to normal – or at least the new normal in the post-COVID world.
The COVID-19 pandemic presents an opportunity to refocus scholarly attention on the politics of crisis. Crises that abruptly upend political and economic relations are important and increasing in frequency. However, the division of international relations into international political economy (IPE) and international security has contributed to the relative neglect of non-militarized crises like pandemics. Crises are defined by threat, uncertainty, and time pressure: understanding them requires a careful examination of how these variables affect political and economic outcomes. Drawing on often disparate literatures on finance, energy and climate change, natural disasters, pandemics, and violent conflict, I propose a broad research program around the politics of crisis, focusing on puzzles related to causes, responses, and transformations.
Implementing disaster exercises in different parts of the health system is one of the important steps in providing and developing disaster risk management plans. Considering the importance of promoting health system preparedness through exercise, the present study aimed to identify and explain necessary and original components for successful implementation of preparedness exercises of the health-care system in disaster.
The study was a qualitative content analysis. Data were collected by purposeful sampling through in-depth and semi-structured individual interviews with 25 health professionals in disaster. Directed content analysis was used to analyze the data, which extracted the initial codes after performing the recorded interviews on paper and immersing them in the data analysis.
The data analysis resulted in the production of 100 initial codes, 14 subcategories, 6 main categories of “coordination and information management,” “standards and indicators,” “conduction and control of the process,” “logistic management and supplies,” “management of treatment operation,” and “management of health operation,” under the original theme of “implementation of exercise.”
The findings of this study can greatly increase the attention of senior managers to preparedness in all areas of the health system, especially managers of prehospitals and hospitals who are the forefront of the response to the disaster. The findings of this study can be considered as a guideline for the implementation of principle and standardized health system preparedness exercises.
Nurses are the first respondents to the critical situations and therefore must be able to effectively manage the critical situations using their competencies. Given that the decision-making style under the stressful critical situations is an important component of the care process in these situations, this study was conducted with the aim of determining the relationship between decision-making style and nurses’ disaster response competencies.
This descriptive, analytical study was conducted in Shahr-e Kord city in 2018. A total of 300 nurses were selected from Ayatollah Kashani and Hajar hospitals by multistage sampling and from the Emergency Medical Services Center by the census method. Data were collected using the Disaster Nursing Competence Assessment and the decision-making style questionnaires and analyzed with SPSS 21 (IBM Corp, Armonk, NY).
Most of the nurses used the intuitive decision-making style and the total score of disaster nursing competencies was 162.58 ± 22.70. Pearson’s correlation coefficient indicated that there was a positive relation between decision-making style and nurses’ disaster response competencies.
The results show that decision-making style affects nurses’ competencies for disaster response and provides evidence for the development of educational policies in disaster nursing education.
The Radiation Injury Treatment Network (RITN) is prepared to respond to a national disaster resulting in mass casualties with marrow toxic injuries. How effective existing RITN workforce education and training is, or whether health-care providers (HCPs) at these centers possess the knowledge and skills to care for patients following a radiation emergency is unclear. HCP knowledge regarding the medical effects and medical management of radiation-exposed patients, along with clinical competence and willingness to care for patients following a radiation emergency was assessed.
An online survey was conducted to assess level of knowledge regarding the medical effects of radiation, medical/nursing management of patients, self-perception of clinical competence, and willingness to respond to radiation emergencies and nuclear events.
Attendance at previous radiation emergency management courses and overall knowledge scores were low for all respondents. The majority indicated they were willing to respond to a radiation event, but few believed they were clinically competent to do so.
Despite willingness to respond, HCPs at RITN centers may not possess adequate knowledge of medical management of radiation patients, and appropriate response actions during a radiation emergency. RITN should increase the awareness of the importance of radiation education and training.