All-Cause Hospital Admissions Among Older Adults After a Natural Disaster

STUDY OBJECTIVE

We characterize hospital admissions among older adults for any cause in the 30 days after a significant natural disaster in the United States. The main outcome was all-cause hospital admissions in the 30 days after natural disaster. Separate analyses were conducted to examine all-cause hospital admissions excluding the 72 hours after the disaster, ICU admissions, all-cause inhospital mortality, and admissions by state.

METHODS

A self-controlled case series analysis using the 2011 Medicare Provider and Analysis Review was conducted to examine exposure to natural disaster by elderly adults located in zip codes affected by tornadoes during the 2011 southeastern superstorm. Spatial data of tornado events were obtained from the National Oceanic and Atmospheric Administration's Severe Report database, and zip code data were obtained from the US Census Bureau.

RESULTS

All-cause hospital admissions increased by 4% for older adults in the 30 days after the April 27, 2011, tornadoes (incidence rate ratio 1.04; 95% confidence interval 1.01 to 1.07). When the first 3 days after the disaster that may have been attributed to immediate injuries were excluded, hospitalizations for any cause also remained higher than when compared with the other 11 months of the year (incidence rate ratio 1.04; 95% confidence interval 1.01 to 1.07). There was no increase in ICU admissions or inhospital mortality associated with the natural disaster. When data were examined by individual states, Alabama, which had the highest number of persons affected, had a 9% increase in both hospitalizations and ICU admissions.

CONCLUSION

When all time-invariant characteristics were controlled for, this natural disaster was associated with a significant increase in all-cause hospitalizations. This analysis quantifies acute care use after disasters through examining all-cause hospitalizations and represents an important contribution to building models of resilience-the ability to recover from a disaster-and hospital surge capacity.

Suicidal ideation among adolescents following natural disaster: The role of prior interpersonal violence

OBJECTIVE

The current study examined variables, including prior traumatic events, disaster exposure, and current mental health symptomatology, associated with suicidal ideation following experience of a natural disaster.

METHOD

Utilizing a sample of 2,000 adolescents exposed to the spring 2011 tornadoes in the areas surrounding Tuscaloosa, Alabama, and Joplin, Missouri, we hypothesized that prior interpersonal violence (IPV), more so than other prior traumatic events or other symptoms, would be associated with suicidal ideation after the disaster.

RESULTS

Suicidal ideation was reported by approximately 5% of the sample. Results of binary logistic regression were consistent with hypotheses in that prior IPV exposure emerged as the variable most robustly related to presence of postdisaster suicidal ideation, even accounting for current symptoms (i.e., posttraumatic stress disorder and depression). Moreover, neither prior accident nor prior natural disaster exposure was significantly associated with postdisaster suicidal ideation, suggesting that something specific to IPV may be conferring risk for suicidality. No other variables, including disaster exposure variables or demographic characteristics, emerged as significantly related.

CONCLUSIONS

Our results suggest that individuals who have a history of IPV may be particularly vulnerable following experience of additional traumatic events and that for suicide risk, the experience of prior IPV may be more relevant to consider in the aftermath of natural disasters beyond variables related to the index trauma or current symptomatology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Individual relocation decisions after tornadoes: a multi-level analysis

This study examines how multi-level factors affected individuals' relocation decisions after EF4 and EF5 (Enhanced Fujita Tornado Intensity Scale) tornadoes struck the United States in 2013. A telephone survey was conducted with 536 respondents, including oversampled older adults, one year after these two disaster events. Respondents' addresses were used to associate individual information with block group-level variables recorded by the American Community Survey. Logistic regression revealed that residential damage and homeownership are important predictors of relocation. There was also significant interaction between these two variables, indicating less difference between homeowners and renters at higher damage levels. Homeownership diminished the likelihood of relocation among younger respondents. Random effects logistic regression found that the percentage of homeownership and of higher income households in the community buffered the effect of damage on relocation; the percentage of older adults reduced the likelihood of this group relocating. The findings are assessed from the standpoint of age difference, policy implications, and social capital and vulnerability.

You plan, you test and then it happens: Lessons learned from the Schneider warehouse tornado recovery

This paper is about the experience gained and lessons learned while dealing with the long-term recovery of Schneider's Port Logistics Division following extensive damage to three warehouse/ office facilities in Savannah, GA on 25th April, 2015. This paper will provide insight into how the initial assessments were handled, how the skill sets needed by the response teams were determined, and what further actions were triggered as more detailed information was received and assessed by the leadership team. This paper will also provide information as to how closely the company followed its existing contingency and disaster recovery plans, as well as where those plans fell short and where it was necessary to make adjustments as the recovery progressed.

User perception and interpretation of tornado probabilistic hazard information: Comparison of four graphical designs

Effective design for presenting severe weather information is important to reduce devastating consequences of severe weather. The Probabilistic Hazard Information (PHI) system for severe weather is being developed by NOAA National Severe Storms Laboratory (NSSL) to communicate probabilistic hazardous weather information. This study investigates the effects of four PHI graphical designs for tornado threat, namely, "four-color"," red-scale", "grayscale" and "contour", on users' perception, interpretation, and reaction to threat information. PHI is presented on either a map background or a radar background. Analysis showed that the accuracy was significantly higher and response time faster when PHI was displayed on map background as compared to radar background due to better contrast. When displayed on a radar background, "grayscale" design resulted in a higher accuracy of responses. Possibly due to familiarity, participants reported four-color design as their favorite design, which also resulted in the fastest recognition of probability levels on both backgrounds. Our study shows the importance of using intuitive color-coding and sufficient contrast in conveying probabilistic threat information via graphical design. We also found that users follows a rational perceiving-judging-feeling-and acting approach in processing probabilistic hazard information for tornado.

Assessment of the Public Health Risks and Impact of a Tornado in Funing, China, 23 June 2016: A Retrospective Analysis

(1) Background: Tornadoes are one of the deadliest disasters but their health impacts in China are poorly investigated. This study aimed to assess the public health risks and impact of an EF-4 tornado outbreak in Funing, China; (2) Methods: A retrospective analysis on the characteristics of tornado-related deaths and injuries was conducted based on the database from the Funing's Center for Disease Control and Prevention (CDC) and Funing People's Hospital. A change-point time-series analysis of weekly incidence for the period January 2010 to September 2016 was used to identify sensitive infectious diseases to the tornado; (3) Results: The 75 to 84 years old group was at the highest risk of both death (RR = 82.16; 95% CIs = 19.66, 343.33) and injury (RR = 31.80; 95% CI = 17.26, 58.61), and females were at 53% higher risk of death than males (RR = 1.53; 95% CIs = 1.02, 2.29). Of the 337 injuries, 274 injuries (81%) were minor. Most deaths occurred indoors (87%) and the head (74%) was the most frequent site of trauma during the tornado. Five diseases showed downward change-points; (4) Conclusions: The experience of the Funing tornado underscores the relative danger of being indoors during a tornado and is successful in avoiding epidemics post-tornado. Current international safety guidelines need modification when generalized to China.

Prepare to protect: Operating and maintaining a tornado safe room

Operating and maintaining a tornado safe room can be critical to the effective continuity of business operations because a firm's most valuable asset is its people. This paper describes aspects of operations and maintenance (O&M) for existing tornado safe rooms as well as a few planning and design aspects that affect the ultimate operation of a safe room for situations where a safe room is planned, but not yet constructed. The information is based on several Federal Emergency Management Agency safe room publications that provide guidance on emergency management and operations, as well as the design and construction of tornado safe rooms.

Relying on the National Mobile Disaster Hospital as a business continuity strategy in the aftermath of a tornado: The Louisville experience

On 28th April, 2014, a tornado left much of Louisville, MS and the local hospital, Winston Medical Center, in ruin. In the USA, temporary hospital solutions have been used to augment the mainstream healthcare system since the American Civil War. As memories fade, however, the necessary readiness for a temporary hospital also fades, at times leaving a patchwork of resources either underfunded or abandoned. With the creation of the Hospital Preparedness Program, several temporary hospital solutions were created in various states across the USA. In the present case, Mississippi and North Carolina resources were used in Louisville in the aftermath of a direct impact that destroyed the hospital and nursing home. In the hours that followed, after lives were saved and patients safely relocated, a frank assessment confirmed the structural loss of the hospital. Local emergency responders, hospital staff, state and federal representatives all rallied with the aim of saving the community's only hospital. The steps taken in Louisville and the deliberate restoration of these essential services offer a learning opportunity for all involved in healthcare disaster preparedness, response and recovery.

Facebook and Twitter, communication and shelter, and the 2011 Tuscaloosa tornado

This paper represents one of the first attempts to analyse the many ways in which Facebook and Twitter were used during a tornado disaster. Comparisons between five randomly selected campus samples and a city of Tuscaloosa, Alabama, sample revealed that campus samples used Facebook and Twitter significantly more both before and after the tornado, but Facebook usage was not significantly different after the event. Furthermore, differences in social media usage and other forms of communication before the tornado were found for age, education, and years lived in Tuscaloosa. Generally, age and education were inversely proportionate to social media usage. Influences on shelter-seeking actions varied between social media users and three random samples of non-social media users; however, it appears that social media respondents were likely to be using a smartphone simultaneously to access warning polygon information, to receive text message alerts, and to listen or respond to environmental cues.

Deconstruction of destruction stories: narrative, inequality, and disasters

A commonly-held belief is that natural disasters do not discriminate. This paper, though, poses the following theoretical question: what does the elision of race, class, and gender in the news media say about disasters in the neoliberal era? It draws on the author's analysis of two prominent newspapers-The New York Times and USA Today-and their coverage of the recovery process after devastating tornadoes in two towns in the United States (Tuscaloosa, Alabama, and Joplin, Missouri) in 2011. The study asserts that the narrative of the news media is one with which people are familiar and that it fits into larger 'formula stories'. It utilises theoretical treatments of narrative to demonstrate how differences are erased and how they lead to complicity in hegemonic representations. Critical theory is used to elucidate why this occurs, and the paper sources Goldberg (2002) in suggesting that the news media employs 'fantasies of homogenisation' when representing post-disaster communities.

Bridging cultures: Nonprofit, church, and emergency management agency collaboration after the May 2013 Oklahoma tornado outbreak

Community-based organizations, such as nonprofit organizations (NPOs) and churches, play an important role in helping individuals and communities bounce back after a disaster. The nature of disasters requires organizations across sectors to partner together to provide recovery services; however, collaboration is difficult even in times of stability and requires trust and communication to be built through prior collaborative relationships. These prior relationships rarely exist between the majority of the nonprofit sector, churches, and existing emergency management structures. Furthermore, these organizations often have very different cultures, values, and norms that can further hinder successful postdisaster collaboration. The authors use data collected from interviews with nonprofit and church leaders involved in recovery efforts after a series of devastating storms impacted central Oklahoma in 2013 to understand how well nonprofit and church leaders perceive their organizations collaborated with each other and with government and emergency management agencies in response and recovery efforts. Interview data suggest that NPOs and churches without a primary or secondary mission of disaster response and recovery have a difficult time collaborating with organizations involved in existing emergency management structures. The authors suggest that nonprofits with a primary or secondary purpose in disaster response are a potential bridge between other nonprofits and emergency management agencies.

Pre-Post Tornado Effects on Aggressive Children's Psychological and Behavioral Adjustment Through One-Year Postdisaster

Using a risk-resilience framework, this study examined how varying levels of exposure to a natural disaster (EF-4 tornado) and children's characteristics (sex; anxiety) influenced the behavioral and psychological adjustment of children who shared a common risk factor predisaster (elevated aggression) prior to exposure through 1-year postdisaster. Participants included 360 children in Grades 4-6 (65% male; 78% African American) and their parents from predominantly low-income households who were already participating in a longitudinal study of indicated prevention effects for externalizing outcomes when the tornado occurred in 2011. Fourth-grade children who were screened for overt aggressive behavior were recruited in 3 annual cohorts (120 per year, beginning in 2009). Parent-rated aggression and internalizing problems were assessed prior to the tornado (Wave 1), within a half-year after the tornado (Wave 2), and at a 1-year follow-up (Wave 3). Children and parents rated their exposure to aspects of tornado-related traumatic experiences at Wave 3. Children displayed less reduction on aggression and internalizing problems if the children had experienced distress after the tornado or fears for their life, in combination with their pre-tornado level of anxiety. Higher levels of children's and parents' exposure to the tornado interacted with children's lower baseline child anxiety to predict less reduction in aggression and internalizing problems 1 year after the tornado. Higher levels of disaster exposure negatively affected at-risk children's level of improvement in aggression and internalizing problems, when life threat (parent- and child-reported) and child-reported distress after the tornado were moderated by baseline anxiety.

Community emergency department utilization following a natural disaster (the Goderich Tornado)

INTRODUCTION

On 21 August 2011 an F3 tornado hit the Canadian town of Goderich, Ontario, leaving 40 people injured and one dead. Specific medium-term changes in utilization of health care following a disaster have not been analyzed in medical literature. Documenting the emergency department utilization through this subacute period would be helpful to enable institutions and healthcare practitioners to be better prepared for future events.

METHODS

A medical chart review was conducted at the Alexandra Marine and General Hospital in Goderich. All emergency department visits made during the 30 days after the Tornado in 2011 (intervention group), 30 days prior to the tornado in 2011 (primary control group), and during the similar calendar period of 30 days after the tornado in 2010 (seasonal control group) were reviewed. Medical diagnoses of all patients who presented at the emergency department were collected and compared.

RESULTS

Fewer people presented to the emergency department following the tornado than during the control periods, and those who did were significantly older than those who presented in the control periods (p<0.001). A significantly greater number of patients presented with undiagnosed medical problems, many came to refill their medications, and significantly fewer people left the emergency department without being seen (p<0.001).

CONCLUSIONS

This study identifies the medical conditions that are most likely to be seen in an emergency department following a tornado in a rural Ontario community. This information serves to inform the medical community and other hospitals how to increase their level of preparedness should a comparable disaster occur again in the future.

Traumatic lung injury attributed to tornadic activity-induced barometric pressure changes in two dogs

CASE DESCRIPTION A 7-year-old castrated male Italian Greyhound (dog 1) and an approximately 1-year-old female Labrador Retriever (dog 2) were evaluated because of respiratory distress 8 and 10 days, respectively, after a tornado. CLINICAL FINDINGS No obvious external injuries were identified auscultation revealed decreased bronchovesicular sounds in the affected hemithorax of both dogs. Clinicopathologic changes were mild, with evidence of inflammation in both dogs. Thoracic radiography of both dogs revealed pneumothorax and pleural effusion with effacement of the diaphragm; findings on CT included severe pulmonary atelectasis of affected lung lobes with normal bronchial tree configurtion and no evidence of diaphragmatic hernia. TREATMENT AND OUTCOME Exploratory thoracotomy of both dogs confirmed CT findings Pulmonary parenchymal damage consistent with a large rupture was found in both patients. A large hematoma was adhered to the ruptured lung lobe of dog 1. Grossly affected lung tissue was removed; histologic examination revealed atelectasis, pulmonary fib osis, thrombosis, and minimal (dog 1) to marked (dog 2) inflammation Microbial culture of lung tissue yielded no growth for dog 1 and Streptococcus spp and Escherichia coli susceptible to amoxicillin-clavulanic acid for dog 2. Dog 1 had a recurrence of pneumothorax treated by drainage with a thoracostomy tube 1 month after surgery. Eighteen months after surgery, both dogs were reportedly doing well. CLINICAL RELEVANCE Development of clinical signs after a tornado, together with clinical, diagnostic imaging, surgical, and histologic findings led to a presumptive diagnosis of pulmonary barotrauma for both dogs. Long-term outcome for these dogs, treated at a referral hospital, was good.

Web Intervention for Adolescents Affected by Disaster: Population-Based Randomized Controlled Trial

OBJECTIVE

To assess the efficacy of Bounce Back Now (BBN), a modular, Web-based intervention for disaster-affected adolescents and their parents.

METHOD

A population-based randomized controlled trial used address-based sampling to enroll 2,000 adolescents and parents from communities affected by tornadoes in Joplin, MO, and several areas in Alabama. Data collection via baseline and follow-up semi-structured telephone interviews was completed between September 2011 and August 2013. All families were invited to access the BBN study Web portal irrespective of mental health status at baseline. Families who accessed the Web portal were assigned randomly to 1 of 3 groups: BBN, which featured modules for adolescents and parents targeting adolescents' mental health symptoms; BBN plus additional modules targeting parents' mental health symptoms; or assessment only. The primary outcomes were adolescent symptoms of posttraumatic stress disorder (PTSD) and depression.

RESULTS

Nearly 50% of families accessed the Web portal. Intent-to-treat analyses revealed time × condition interactions for PTSD symptoms (B = -0.24, SE = 0.08, p < .01) and depressive symptoms (B = -0.23, SE = 0.09, p < .01). Post hoc comparisons revealed fewer PTSD and depressive symptoms for adolescents in the experimental versus control conditions at 12-month follow-up (PTSD: B = -0.36, SE = 0.19, p = .06; depressive symptoms: B = -0.42, SE = 0.19, p = 0.03). A time × condition interaction also was found that favored the BBN versus BBN + parent self-help condition for PTSD symptoms (B = 0.30, SE = 0.12, p = .02) but not depressive symptoms (B = 0.12, SE = 0.12, p = .33).

CONCLUSION

Results supported the feasibility and initial efficacy of BBN as a scalable disaster mental health intervention for adolescents. Technology-based solutions have tremendous potential value if found to reduce the mental health burden of disasters.

CLINICAL TRIAL REGISTRATION INFORMATION

Web-based Intervention for Disaster-Affected Youth and Families; http://clinicaltrials.gov; NCT01606514.

Dynamical analysis and visualization of tornadoes time series

In this paper we analyze the behavior of tornado time-series in the U.S. from the perspective of dynamical systems. A tornado is a violently rotating column of air extending from a cumulonimbus cloud down to the ground. Such phenomena reveal features that are well described by power law functions and unveil characteristics found in systems with long range memory effects. Tornado time series are viewed as the output of a complex system and are interpreted as a manifestation of its dynamics. Tornadoes are modeled as sequences of Dirac impulses with amplitude proportional to the events size. First, a collection of time series involving 64 years is analyzed in the frequency domain by means of the Fourier transform. The amplitude spectra are approximated by power law functions and their parameters are read as an underlying signature of the system dynamics. Second, it is adopted the concept of circular time and the collective behavior of tornadoes analyzed. Clustering techniques are then adopted to identify and visualize the emerging patterns.

Predictors of compliance with tornado warnings issued in Joplin, Missouri, in 2011

Joplin, a city in the southwest corner of Missouri, United States, suffered an EF-5 tornado in the late afternoon of 22 May 2011. This event, which claimed the lives of 162 people, represents the deadliest single tornado to strike the US since modern record-keeping began in 1950. This study examines the factors associated with responses to tornado warnings. Based on a post-tornado survey of survivors in Joplin, it reveals that tornado warnings were adequate and timely. Multivariate logistic regression identified four statistically significant determinants of compliance with tornado warnings: number of warning sources, whether respondents were at home when the tornado struck, past tornado experience, and gender. The findings suggest several recommendations, the implementation of which will further improve responses to tornado warnings.

Assessing American Red Cross First Aid mobile app user trends: Implications for resilience

OBJECTIVE

Disasters have devastated communities, impacted the economy, and resulted in a significant increase in injuries. As the use of mobile technology increasingly becomes a common aspect of everyday life, it is important to understand how it can be used as a resource. The authors examined the use of American Red Cross mobile apps and aimed to characterize user trends to better understand how mobile apps can help bolster individual and community preparedness, resilience, and response efforts.

DESIGN/MAIN OUTCOME MEASURES

Tornado data were obtained from the National Oceanic and Atmospheric Administration and the National Weather Service. Data for the mobile apps were provided by the American Red Cross. All data were reviewed for 2013, 2014, and three specific tornado events. Data were organized in Microsoft Excel spreadsheets and then graphed or mapped using ArcMap 10.2(™).

RESULTS

Between 2013 and 2014, 1,068 tornado watches and 3,682 tornado warnings were issued. Additionally, 37,957,560 Tornado app users and 1,289,676 First Aid app users were active from 2013 to 2014. Overall, there was an increase in the use of American Red Cross mobile apps during tornado occurrences. Yet the increase does not show a consistent correlation with the number of watches and warnings issued.

CONCLUSIONS

Mobile apps can be a resourceful tool. This study shows that mobile app use increases during a disaster. The findings indicate that there is potential to use mobile apps for building resilience as the apps provide information to support individuals and communities in helping before, during, and after disasters.

Tornado intensity estimated from damage path dimensions

The Newcastle/Moore and El Reno tornadoes of May 2013 are recent reminders of the destructive power of tornadoes. A direct estimate of a tornado's power is difficult and dangerous to get. An indirect estimate on a categorical scale is available from a post-storm survery of the damage. Wind speed bounds are attached to the scale, but the scale is not adequate for analyzing trends in tornado intensity separate from trends in tornado frequency. Here tornado intensity on a continuum is estimated from damage path length and width, which are measured on continuous scales and correlated to the EF rating. The wind speeds on the EF scale are treated as interval censored data and regressed onto the path dimensions and fatalities. The regression model indicates a 25% increase in expected intensity over a threshold intensity of 29 m s⁻¹ for a 100 km increase in path length and a 17% increase in expected intensity for a one km increase in path width. The model shows a 43% increase in the expected intensity when fatalities are observed controlling for path dimensions. The estimated wind speeds correlate at a level of .77 (.34, .93) [95% confidence interval] with a small sample of wind speeds estimated independently from a doppler radar calibration. The estimated wind speeds allow analyses to be done on the tornado database that are not possible with the categorical scale. The modeled intensities can be used in climatology and in environmental and engineering applications. Research is needed to understand the upward trends in path length and width.

Working after a tornado: a survey of hospital personnel in Joplin, Missouri

In 2011, an EF5 tornado hit Joplin, MO, requiring complete evacuation of 1 hospital and a patient surge to another. We sought to assess the resilience of healthcare workers in these hospitals as measured by number reporting to work, willingness to work, personal disaster preparedness, and childcare responsibilities following the disaster. In May 2013, a survey was distributed to healthcare workers at both Joplin hospitals that asked them to report their willingness to work and personal disaster preparedness following various disaster scenarios. For those with childcare responsibilities, scheduling, costs, and impact of hypothetical alternative childcare programs were considered in the analyses. A total of 1,234 healthcare workers completed the survey (response rate: 23.4%). Most (87.8%) worked the week following the Joplin tornado. Healthcare workers report more willingness to work during a future earthquake or tornado compared to their pre-Joplin tornado attitudes (86.2 vs 88.4%, t=-4.3, p<.001; 88.4 vs 90%, t=-3.1, p<.01, respectively), with no change during other scenarios. They expressed significantly higher post-tornado personal disaster preparedness, but only preevent preparedness was a significant predictor of postevent preparedness. Nearly half (48.5%, n=598) had childcare responsibilities; 61% (n=366) had childcare needs the week of the tornado, and 54% (n=198) required the use of alternative childcare. If their hospital had provided alternative childcare, 51% would have used it and 42% felt they would have been more willing to report to work. Most healthcare workers reported to work following this disaster, demonstrating true resilience. Disaster planners should be aware of these perceptions as they formulate their own emergency operation plans.