Hospital Disaster Preparedness Tools: a Systematic Review

Exploring hospitals' functional preparedness effective factors in response to disasters: a qualitative study in a lower middle-income country

BACKGROUND

Medical services are among the most urgent needs of the disaster-affected population. Consequently, hospital preparedness -as the main health services provider- is one of the vital factors in effective response to disasters. The present study aims to explore the perspectives of study participants about the influential factors of hospital functional preparedness in a lower middle-income country.

METHODS

In this qualitative study, data were collected through 17 semi-structured interviews with disaster management authorities selected by purposive sampling. Content-Analysis was used to analyze the data.

RESULTS

138 codes were developed and categorized into ten categories and 34 subcategories. The main categories were: 1- leadership, command, and coordination (4 subcategories); 2- risk assessment (3 subcategories); 3- legislating and developing protocols, guidelines, and programs (3 subcategories); 4- estimating and storing the necessary supplies and equipment (3 subcategories); 5- human resource management (4 subcategories); 6- education, training, and development of staff (6 subcategories); 7- vital routes and facilities (3 subcategories); 8- communication (3 subcategories); 9- security, safety and locating of safe zones (3 subcategories); 10- underlying disaster risk factors (2 subcategories).

CONCLUSION

According to the participants of this study, ten categories of factors can affect hospitals' functional preparedness; hospital managers and decision-makers can consider these factors to ensure the proper provision of medical services during disasters.

The Impact of Exposure to Previous Disasters on Hospital Disaster Surge Capacity Preparedness in Finland: Hospital disaster surge capacity preparedness

OBJECTIVE

As disasters are rare and high-impact events, it is important that the learnings from disasters are maximized. The aim of this study was to explore the effect of exposure to a past disaster or mass casualty incident (MCI) on local hospital surge capacity planning.

METHODS

The current hospital preparedness plans of hospitals receiving surgical emergency patients in Finland were collected (n = 28) and analyzed using the World Health Organization (WHO) hospital emergency checklist tool. The surge capacity score was compared between the hospitals that had been exposed to a disaster or MCI with those who had not.

RESULTS

The overall median score of all key components on the WHO checklist was 76% (range 24%). The median surge capacity score was 65% (range 39%). There was no statistical difference between the surge capacity score of the hospitals with history of a disaster or MCI compared to those without (65% for both, P = 0.735).

CONCLUSION

Exposure to a past disaster or MCI did not appear to be associated with an increased local hospital disaster surge capacity score. The study suggests that disaster planning should include structured post-action processes for enabling meaningful improvement after an experienced disaster or MCI.

Systematic review on the current state of disaster preparation Simulation Exercises (SimEx)

INTRODUCTION

The simulation exercise (SimEx) simulates an emergency in which an elaboration or description of the response is applied. The purpose of these exercises is to validate and improve plans, procedures, and systems for responding to all hazards. The purpose of this study was to review disaster preparation exercises conducted by various national, non-government, and academic institutions.

METHODOLOGY

Several databases, including PubMed (Medline), Cumulative Index to Nursing and Allied Health Literature (CINAHL), BioMed Central, and Google Scholar, were used to review the literature. Information was retrieved using Medical Subject Headings (MeSH) and documents were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). To assess the quality of the selected articles, the Newcastle-Ottawa Scale (NOS) technique was utilized.

RESULTS

A total of 29 papers were selected for final review based on PRISMA guidelines and the NOS quality assessment. Studies have shown that many forms of SimEx commonly used in disaster management including tabletop exercises, functional exercises, and full-scale exercises have their benefits and limitations. There is no doubt that SimEx is an excellent tool for improving disaster planning and response. It is still necessary to give SimEx programs a more rigorous evaluation and to standardize the processes more thoroughly.

CONCLUSIONS

Drills and training can be improved for disaster management, which will enable medical professionals to face the challenges of disaster management in the 21st century.

A Qualitative Study on the Use of the Hospital Safety Index and the Formulation of Recommendations for Future Adaptations

The Hospital Safety Index is a tool developed by the World Health Organization and the Pan American Health Organization in 2008 and updated in 2015. Although it is the most widely used instrument of its kind to assess the level of hospital preparedness, scientific literature on its application in real life is scarce. This study aimed to investigate the use of the Hospital Safety Index to assess disaster preparedness in healthcare facilities. A retrospective, qualitative study employing semi-structured online interviews was conducted to gather the opinions and perspectives of professionals who have experience in applying the Hospital Safety Index. Authors of scientific publications using the Hospital Safety Index were recruited. A semi-structured interview guide was developed. It addressed different phases of data collection with the Hospital Safety Index, the challenges and facilitators of using it, and recommendations for future adaptations. Data were analysed using inductive thematic analysis. Nine participants who were from three countries (Serbia, Sri Lanka, and Indonesia) and had different professional backgrounds (medical doctors, engineers, spatial planners, etc.) participated in this study. A total of 5 themes and 15 subthemes emerged during data analysis. Most of the participants reported their reasons for choosing the Hospital Safety Index as being its comprehensiveness and the fact that it was issued by the World Health Organization. The tool appears to be very specific and allows investigators to spot details in hospitals; however, it is not easy to use, and training is highly encouraged to learn how to navigate the different components of the tool. Governmental support is a crucial facilitator for investigators to be able to enter hospitals and conduct their evaluations. Overall, the tool has a lot of potential, and it should be used to reach a broader audience, such as community members, and assess the preparedness of other facilities that can take part in the response to disasters (hotels, stadiums, schools, etc.). Nevertheless, it still needs more adaptations to be tailored to different contexts and settings.

Design and validation of a preparedness evaluation tool of pre-hospital emergency medical services for terrorist attacks: a mixed method study

INTRODUCTION

Terrorist attacks are one of the human problems that affect many countries, leaving behind a huge toll of disabilities and deaths. The aim of this study was to use a mixed-method analysis to design and validate an evaluation tool for pre-hospital emergency medical services for terrorist attacks.

METHODS

The present study is a mixed-method (qualitative and quantitative) study that was conducted in two phases. In the qualitative phase (item generation), semi-structured interviews were conducted with 34 Iranian emergency medical technicians who were selected through a purposive sampling method and a scoping literature review was conducted to generate an item pool for the preparedness evaluation of Emergency Medical Services (EMS) in terrorist attacks. In the quantitative phase (item reduction), for validity of tool face, content and construct validity, were performed; for tool reliability, the test and retest and intra-class correlation coefficient were evaluated.

RESULTS

At the first stage, 7 main categories and 16 subcategories were extracted from the data, the main categories including "Policy and Planning", "Education and Exercise "," Surge Capacity", "Safety and Security", "Command, Control and Coordination", "Information and Communication Management "and "Response Operations Management". The initial item pool included 160 items that were reduced to 110 after assessment of validity (face, content and construct). intra-class correlation coefficient (ICC = 0.71) examination and Pearson correlation test (r = 0.81) indicated that the tool was also reliable.

CONCLUSION

The research findings provide a new perspective to understand the preparedness of pre-hospital emergency medical services for terrorist attacks. The existing 110-item tool can evaluate preparedness of pre-hospital emergency medical services for terrorist attacks through collecting data with appropriate validity and reliability.

A qualitative content analysis for determining indexes and factors affecting for evaluation of disaster exercises immediate feedback stage

BACKGROUND

Taking exercise in health sector is one of the important steps to implement the disaster risk management programs, especially preparedness phase. The present study aimed to identify indexes and factors affecting successful evaluation of disasters preparedness exercises in hot wash stage.

MATERIALS AND METHODS

This 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 the field of disasters. The data were analyzed using directed content analysis method by which the initial codes were extracted after transcribing the recorded interviews and immersing them in the data analysis. The initial codes were reviewed, classified, and subdivided into several stages to determine the main classes.

RESULTS

The data analysis resulted in the production of 24 initial codes, 5 subcategories, 2 main categories of "evaluation and exercise debriefing" and "modification of programs and promotion of exercise operational functions" under the original theme of "exercise immediate feedback."

CONCLUSION

This study can be considered a suitable standard guide for health care organizations to evaluate successfully disasters exercises in hot wash stage, maintain and promote their preparedness, and properly respond to disasters.

Development of Hospital MCI and Disaster Preparedness Assessment Tool for Thailand

Introduction

Hospital preparedness is a key component to mitigate the effects of mass casualty incidents (MCIs) and disasters. Improving hospital preparedness requires an assessment of the country's current health system capacity, readiness, and preparedness. Although a variety of assessment tools exist, none are entirely suitable for Thailand's healthcare system.

Objective

To develop an assessment tool to evaluate hospital preparedness for MCI and disaster in Thailand.

Methods

A cross-sectional study was conducted from 1 March 2015 to December 2016. The contents of the first drafted tool were prepared based on evidence from a systematic search of electronic databases published up to 31 December 2014. Key elements identification, extraction, and further organization were based on the World Health Organization health system framework. Validity was tested by experts and emergency management personnel in four domains using a 5-point scale evaluation form. The feasibility of using this assessment tool was carried out in 41 hospitals on a voluntary basis. The tool was considered valid if the item-objective congruence (IOC) index results were at least 0.6 and feasible for median values of at least 4.

Results

Seventy-six full texts and guidelines out of 5869 titles and abstracts from a systematic search were enrolled in the study. A constructive literature review was performed to develop a hospital assessment tool. The IOC index results of the assessment tool components were 1.0, 0.9, 0.7, and 1.0 in framework appropriateness, relevance of items, clearness, and usefulness, respectively. The median (interquartile range) values of framework appropriateness, relevance of items, clearness, and usefulness were 4.0 (4.0‒5.0), 4.3 (4.3‒4.5), 4.0 (4.0‒4.0), and 5.0 (4.0‒5.0), respectively.

Conclusion

An assessment tool to evaluate hospital MCI and disaster preparedness based on the WHO health system framework was valid and feasible at the national level of Thailand.

Disaster preparedness in emergency medical service agencies: A systematic review

The Emergency Medical Services (EMSs) are in the frontline between the health-care systems and people in emergencies and disasters. With the increase in the frequency of natural or man-made disasters around the world, the need for prepared EMS services is increasing. This study aimed to evaluate the current disaster preparedness status of the EMS agencies in the literature and exploring the key preparedness elements and the strategies to improve the EMS disaster preparedness. The electronic database such as PubMed, Web of Science, Scopus, and Google Scholar was searched from 2000 to 2019. The searching keywords included: "EMS," "Disaster," "Preparedness," "Emergency" "Preparedness," "Disaster Preparedness," "Readiness," and the terms related to "disaster types" were used in combination with Boolean operators OR and AND. Out of 1412 articles, 7 articles were included in the review. The most important elements of the EMS disaster preparedness include the size and scope of the incident, surge capacity, planning, communication, training and education, policymaking, financial support, coordination, safety and security, early warning system, disaster response experience, and legal considerations. This systematic review showed that the EMS agencies in the world generally are inadequately prepared for an effective response to major emergencies and disasters. This study provides valuable information to EMS educators, EMS administrators to adopt and perform appropriate activities to improve the EMS disaster preparedness.

"Expecting the Unexpected:" Nurses' Response and Preparedness of Terrorism-Related Disaster Events in Quetta City, Pakistan

Background: In addition to the psychiatric and societal misery, terrorism places an exceptional burden while delivering healthcare services. Accordingly, a responsive and well-prepared healthcare system ensures effective management of terrorism-related events. Within this context, with a strong historic grounding in addressing situations of societal crisis nurses are well-placed in contributing to the global arena of humanitarian policy and social research. Therefore, assessing their response and preparedness is vital in effective management of a terrorism-related disaster. For that very reason, we aimed to evaluate nurses' preparedness and response toward terrorism-related disaster events in Quetta city, Pakistan. Methods: A qualitative design was adopted to explore nurses' response and preparedness of terrorism-related disaster events. By using a semi-structured interview guide through the phenomenology-based approach, in-depth, face-to-face interviews were conducted. Nurses practicing at the Trauma Center of Sandeman Provincial Hospital (SPH), Quetta, were approached for the study. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Results: Fifteen nurses were interviewed and thematic content analysis revealed five themes. All nurses have experienced, responded to, and managed terrorism-related disaster events. They were prepared both professionally and psychologically in dealing with a terrorism-related disaster. Among limitations, space and workforce were highlighted by almost all the respondents. Lack of disaster-related curricula, absence of a protocol, recurrence of the disaster, and hostile behavior of victim's attendants during an emergency were highlighted as a key barrier toward terrorism-related disaster management. Conclusion: The skills and expertise needed to address a terrorism-related disaster are well-understood by the nurses but are lacking for various reasons. In addition to the review and adaption of the nursing curriculum specifically for terrorism-related disaster management, collaboration and dialogue between various stakeholders is required to efficiently manage terrorism-related disaster events.

Adaptation and evaluation of the Chinese hospital nursing department disaster preparedness scale: a cross-sectional scale development study

AIM

The aim of this study was to adapt the Chinese version of Hospital Nursing Department Disaster Preparedness Scale (HNDDPS) and evaluate the psychometric properties among hospital nurses in China. Two specific objectives were (1) to adapt the HNDDPS from Sadiq's Organisational Disaster Preparedness Scale (SODPS) to fit the context of Chinese hospital nursing system and (2) to establish its validity and reliability.

DESIGN

Instrument design study.

SETTINGS AND PARTICIPANTS

2657 nurses belonging to 50 nursing organisations of tertiary hospitals spread across seven administrative regions of China.

METHODS

We adapted the Chinese version of HNDDPS through translation of the SODPS, back translation and cultural adaptation. Subsequently, we evaluated the validity of the scale through exploratory factor analysis and confirmatory factor analysis (CFA), each performed on half of the original sample. We also evaluated the internal consistency reliability of the scale.

RESULTS

The Chinese version of HNDDPS comprised five dimensions, with 72 items. Exploratory factor analysis yielded five factors explaining 61% of the items' variance. CFA confirmed five dimensions of the scale and produced appropriate Goodness of Fit Indexes. Cronbach's α-coefficient was 0.930 for the total scale and ranged from 0.908 to 0.964 for the five dimensions of the scale.

CONCLUSION

HNDDPS demonstrates good internal consistency and construct validity. It is a promising, valid and reliable tool for nurses and nursing managers to evaluate hospital nursing department disaster preparedness.

Cognition and Implementation of Disaster Preparedness among Japanese Dialysis Facilities

Introduction

Few quantitative studies have explored disaster preparedness in dialysis facilities worldwide. This study examined the levels of disaster preparedness and their related factors in dialysis facilities in Japan.

Methods

We conducted a mail survey using a self-administered questionnaire for key persons responsible for disaster preparedness in dialysis facilities (N = 904) associated with the Japanese Association of Dialysis Physicians. Levels of disaster preparedness were evaluated by the implementation rates of four domains: (1) patient, (2) administration, (3) network, and (4) safety. Additionally, we focused on cognitive factors related to disaster preparedness, such as risk perception, outcome expectancy, self-efficacy, self-responsibility, and support from the surroundings.

Results

A total of 517 participants answered the survey (response rate: 57.2%). Implementation rates differed according to the domains of disaster preparedness. While the average implementation rate of the safety domain was 81.8%, each average implementation rate was 57.9%, 48.3%, and 38.4% for the administration, network, and patient domains, respectively. The study found that self-efficacy and support from the surroundings of the participants were significantly associated with the four domains of disaster preparedness. Alternatively, risk perception and support from surroundings were significantly associated with one particular domain each.

Conclusion

Our results suggest that boosting self-efficacy and support from surroundings among key persons of disaster preparedness in dialysis facilities may contribute to the advancement of the different domains of disaster preparedness.

Hospital Disaster Preparedness in Iran: A Systematic Review and Meta-Analysis

BACKGROUND

Disasters are increasing all over the world. Iran, is one of the high-risk countries in this regard; so it is unavoidable to prepare hospitals as vital centers when disasters happen. This study aimed to evaluation the hospital preparedness based on previous studies in Iran.

METHODS

A systematic review and meta-analysis by browsing through all articles published since 2006 to 2017, in English and Persian both languages were designed. Databases that we searched to, include Google Scholar, PubMed, Web of Science, Scopus, Medlib, Cochrane Library, Science Direct, Internationally and SID, Irandoc and Magiran, domestically. Two expert researchers investigated separately. Researchers used random and fixed effect models in the meta-analysis. Moreover, random and fixed effects model and meta-regression tests were applied by using STATA ver. 11. The P<0.05 was considered statistically significant.

RESULTS

Twenty-five studies with a sample size of 181 hospitals were introduced to the process of meta-analysis. Iranian hospital preparedness is 53%, totally, that is moderate. Preparedness in different categories is as follows: emergency services 62%, communication 57%, security 54%, education 57%, logistic 65%, human resources 52%, Management and command 64%, reception 43%, transfer and evacuation 44%, traffic 47%, non-structural safety 57%, and structural safety 49%.

CONCLUSION

Hospital preparedness is moderate in Iran. Optimal management of existing resources and the use of Update technologies in the field of hospital services be directed towards improving the preparedness of hospitals for disasters.

Maintaining Preparedness to Severe Though Infrequent Threats-Can It Be Done?

Background: A mass casualty incident (MCI) caused by toxicological/chemical materials constitutes a potential though uncommon risk that may cause great devastation. Presentation of casualties exposed to such materials in hospitals, if not immediately identified, may cause secondary contamination resulting in dysfunction of the emergency department. The study examined the impact of a longitudinal evaluation process on the ongoing emergency preparedness of hospitals for toxicological MCIs, over a decade. Methods: Emergency preparedness for toxicological incidents of all Israeli hospitals were periodically evaluated, over ten years. The evaluation was based on a structured tool developed to encourage ongoing preparedness of Standard Operating Procedures (SOPs), equipment and infrastructure, knowledge of personnel, and training and exercises. The benchmarks were distributed to all hospitals, to be used as a foundation to build and improve emergency preparedness. Scores were compared within and between hospitals. Results: Overall mean scores of emergency preparedness increased over the five measurements from 88 to 95. A significant increase between T1 (first evaluation) and T5 (last evaluation) occurred in SOPs (p = 0.006), training and exercises (p = 0.003), and in the overall score (p = 0.004). No significant changes were found concerning equipment and infrastructure and knowledge; their scores were consistently very high throughout the decade. An interaction effect was found between the cycles of evaluation and the hospitals’ geographical location (F _(1,20) = 3.0, p = 0.056), proximity to other medical facilities (F _(1,20) = 10.0 p = 0.005), and type of area (Urban vs. Periphery) (F _(1,20) = 13.1, p = 0.002). At T5, all hospitals achieved similar high scores of emergency preparedness. Conclusions: Use of accessible benchmarks, which clearly delineate what needs to be continually implemented, facilitates an ongoing sustenance of effective levels of emergency preparedness. As this was demonstrated for a risk that does not frequently occur, it may be assumed that it is possible and practical to achieve and maintain emergency preparedness for other potential risks.

Developing a Hospital Disaster Risk Management Evaluation Model

Purpose

Disasters are increasing worldwide and hospitals should be prepared to respond well to such disasters. An effective hospital disaster risk management program saves peoples’ lives, reduces damage to the hospital properties and assures hospital service continuity. This article aimed to develop and verify a Hospital Disaster Risk Management Evaluation model (HDRME).

Methods

A mixed-method explanatory sequential approach was used to develop and verify the HDRME model. The first draft of the HDRME model was introduced through a comprehensive literature review of major databases (i.e., PubMed, Scopus, Web of Science, and Science Direct), using appropriate keywords. Furthermore, 18 in-depth individual interviews were conducted with well-known experts in DRM to identify more HDRME constructs, sub-constructs, and standards. Then, three rounds of Delphi were conducted with 22 experts in hospital disaster risk management to verify the proposed model.

Results

The proposed HDRME consists of eight constructs, including seven enablers (management and leadership; risk assessment; planning; prevention and mitigation; preparedness; response, and recovery) and one result (key performance results). These constructs were further broken into 27 sub-constructs. The enablers and results scored 85% and 15% of the model’s total scores.

Conclusion

A comprehensive conceptual framework for the evaluation of hospital disaster risk management was introduced and verified. Standards and measurable elements can be embedded in this conceptual model to measure a hospital’s preparedness in disasters and accordingly, corrective actions can be taken to strengthen the hospitals’ responses to the disasters. However, the proposed model should be validated in a hospital setting through implementation.

Hospital’s preparedness in road traffic injuries with mass casualties: Exploring a valid and reliable checklist

Background:

The most important functional factor of hospitals is having a preparedness plan for dealing with disasters and emergencies such as road traffic injuries. There is a gap in the design and the development of a valid and reliable tool to evaluate the levels of hospital preparedness during road traffic injuries with mass casualty.

Objectives:

The aim of this study was to explore a valid and reliable tool for measurement of hospital preparedness in road traffic injuries with mass casualties.

Methods:

This study was conducted in two phases, each comprising different steps: tool design and judgmental evidence. In the first step, the determination of the content domain, sampling from content (item generation), and the formation of the tool and in the second stage, validity and reliability of the tool were performed.

Results:

From the 139 items that were finally set, nine dimensions including command and control, infrastructure and medical equipment, information and communication systems, surge capacity, triage and medical services, safety and security, human resources management, coordination and cooperation, and training and exercise were identified. Content validity index and content validity ratio of the tool were 0.97 and 0.98, respectively. The reliability of the tool was 0.89 with the kappa coefficient, respectively.

Conclusion:

The tool has sufficient reliability and validity for measuring hospital preparedness in road traffic injuries with mass casualties. Thus, this tool can be used for assessing the preparedness of hospitals for better planning, preparedness, and response to road traffic injuries with mass casualties.

A Productive Proposed Search Syntax for Health Disaster Preparedness Research

Objective:

To find a proper search strategy to do a systematic review related to preparedness for disasters.

Methods:

MeSH and Emtree terms were searched to detect synonyms for two main search terms “disaster” and “preparedness”. Expert opinion on the synonyms was examined applying a Google form. The adopted syntax was searched in PubMed and results were sifted. Hand searching in two top key journals was done and sensitivity was calculated.

Results:

Out of 1120 articles, 122 were included. In PDM journal, 10 articles were included by hand searching, out of which 5 were not spotted in PubMed search with the proposed syntax. In DMPHP journal, 13 publications were included, with 5 not found in PubMed search. Because of human error in hand searching 2 articles were added.

Conclusion:

The proposed syntax in this study achieves a sensitivity of search of 0.6 in PubMed which could be quite applicable for researchers. Moreover, in case only MeSH or Emtree terms were applied in search strategy or where hand searching was not performed, there were a number of articles missed.

A Productive Proposed Search Syntax for Health Disaster Preparedness Research

Objective

To find a proper search strategy to do a systematic review related to preparedness for disasters.

Methods

MeSH and Emtree terms were searched to detect synonyms for two main search terms "disaster" and "preparedness". Expert opinion on the synonyms was examined applying a Google form. The adopted syntax was searched in PubMed and results were sifted. Hand searching in two top key journals was done and sensitivity was calculated.

Results

Out of 1120 articles, 122 were included. In PDM journal, 10 articles were included by hand searching, out of which 5 were not spotted in PubMed search with the proposed syntax. In DMPHP journal, 13 publications were included, with 5 not found in PubMed search. Because of human error in hand searching 2 articles were added.

Conclusion

The proposed syntax in this study achieves a sensitivity of search of 0.6 in PubMed which could be quite applicable for researchers. Moreover, in case only MeSH or Emtree terms were applied in search strategy or where hand searching was not performed, there were a number of articles missed.

Assessment Tools for the Mental Health of School-Aged Children and Adolescents Exposed to Disaster: A Systematic Review (1988-2015)

Objectives

In this study, we aimed to conduct a systematic review of studies investigating psychosocial factors affecting children exposed to disasters.

Methods

In total, 140 studies were retrieved. The studies were published from 1988 to 2015. A systematic review was performed using the PRISMA guidelines. MEDLINE, EMBASE, Cochrane Central, Web of Science, PsycINFO, PubMed, and Google Scholar were searched. Each database was searched using the following terms: 'Child,' 'Adolescent,' 'Youth,' 'Disaster,' 'Posttraumatic,' 'Psychosocial,' 'Assessment,' 'Evaluation,' and 'Screening.' The identified studies were subjected to data extraction and appraisal.

Results

The database search identified 713 articles. Based on the titles and abstracts, the full texts of 118 articles were obtained. The findings of this review can be used as a basis for the design of a psychosocial evaluation tool for disaster preparedness.

Conclusion

Given the paramount importance of post-disaster evaluation and the weaknesses of current disaster evaluation tools, the need to develop valid and reliable tools and psychometric evaluations cannot be overstated. Our findings provide current evidence supporting various assessments in children, who are very vulnerable psychologically following disasters.