Exploring the consequences of nurses' involvement in disaster response: findings from a qualitative content analysis study

BACKGROUND

The presence of nurses during disasters can lead to many consequences. Understanding the nurses' experiences of these consequences can provide valuable insights. Therefore, this study was conducted to explore the experiences of Iranian nurses regarding the consequences they faced when being present during disasters.

METHODS

This qualitative descriptive study employed a content analysis approach to examine the topic at hand. 20 nurses working in the emergency units of Kerman hospitals were selected through purposive sampling. In-depth semi-structured interviews were conducted to collect the data. The data were analyzed using qualitative content analysis proposed by Graneheim and Lundman. MAXQDA 10 was used to manage data.

RESULTS

After analysis of the interviews, two main categories were identified: overlapping of job frustrations and acquiring experience in difficult conditions. The main category of acquiring experience in difficult conditions comprised the following subcategories: improved quality of care, experience and dedication in fulfilling the role, reduced stress, occupational motivation and enthusiasm, increased self-confidence, and improved social status. On the other hand, the category of overlapping of job frustrations also consisted of the subcategories of physical strength deterioration, psychological and emotional distress, discontinued from supports, feelings of hopelessness, increased exposure to violence and aggression, and occurrence of family problems.

CONCLUSION

Being present during disasters and obtaining the necessary competencies can have positive consequences that serve as turning points in the personal and professional growth of nurses. Additionally, favorable outcomes can help nurses cope with adverse circumstances. Managers can utilize the findings of this study to develop strategies aimed at reducing negative outcomes and enhancing positive ones among nurses during disasters.

Development and demonstration of a data visualization platform of short-term guidelines for ambient air levels of benzene during disaster response in Houston, Texas

Industrial disasters have caused hazardous air pollution and public health impacts. Response officials have developed limited exposure guidelines to direct them during the event; often, guidelines are outdated and may not represent relevant elevated-exposure periods. The 2019 Intercontinental Terminals Company (ITC) fire in Houston, Texas led to large-scale releases of benzene and presented a public health threat. This incident highlights the need for effective response and nimble, rapid public health communication. We developed a data-driven visualization tool to store, display, and interpret ambient benzene concentrations to assist health officials during environmental emergencies. Guidance values to interpret risk from acute exposure to benzene were updated using recent literature that also considers exposure periodicity. The visualization platform can process data from different sampling instruments and air monitors automatically, and displays information publicly in real time, along with the associated risk information and action recommendations. The protocol was validated by applying it retrospectively to the ITC event. The new guidance values are 6-30 times lower than those derived by the Texas regulatory agency. Fixed-site monitoring data, assessed using the protocol and revised thresholds, indicated that eight shelter-in-place and 17 air-quality alerts may have been considered. At least one of these shelter-in-place alerts corresponded to prolonged, elevated benzene concentrations (~1000 ppb). This new tool addresses essential gaps in the timely communication of air pollution measurements, provides context to understand potential health risks from exposure to benzene, and provides a clear protocol for local officials in responding to industrial air releases of benzene. Integr Environ Assess Manag 2024;20:533-546. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Community Resilience and Cultural Responses in Crisis: Lessons Learned from Pacific Islander Responses to the COVID-19 Pandemic in the USA

Pacific Islander communities in the USA experienced some of the most severe effects of the COVID-19 pandemic. This qualitative synthesis examines the literature on Pacific Islander community responses and lessons learned from COVID-19, using a systematic search that identified 28 articles with this focus. Thematic analysis was subsequently used to classify both documented efforts by Pacific Islander communities to respond to the pandemic, as well as lessons learned and best practices from research in this area. Results revealed multiple efforts to address the pandemic, including Pacific Islander grassroots approaches, government responses, inter-sector collaboration, and research. Results further emphasized the importance of culturally and linguistically responsive outreach and messaging; partnership, engagement, and capacity building; and changes in research and policy approaches to promote health equity. Future efforts to address public health crises should make the most of Pacific Islander cultural approaches to disaster response. To achieve this, government and other organizations that work with PI communities need to support the development of the PI leadership, healthcare and research workforces, and work with Pacific Islander communities to build long-term, sustainable, and trustworthy partnerships.

Theatre practitioners and organisational adaptive capacity in disaster response

Disasters are increasing globally, requiring flexible strategic approaches from healthcare organisations to manage the resultant influx of patients requiring care while also maintaining normal operational services. Theatre practitioners play a key role in disaster response and recovery; however, a lack of appropriate skill utilisation may be reducing overall organisational adaptive capacity and leading to poorer outcomes for organisations, staff and patients. Understanding what skills individual practitioners have, and how they can be deployed to the greatest effect, is a concern for managers to ensure optimal use of resources and to reduce negative impacts of disaster response upon healthcare personnel. This is especially pertinent in the post-COVID healthcare climate where a paucity of operating theatre practitioners and poor workforce planning has led to a lack of surgical capacity at a time when it is most needed.

Determinants of nurses' readiness for disaster response: A cross-sectional study

Reducing the impacts of disasters is imperative in these times when disasters continually threaten people's lives. Given that the readiness for disaster response of nurses are essential in mitigating damage, however, studies on the determinants of nurses' readiness for disaster response remain inconclusive and require further research, especially with various populations. This study therefore aimed to investigate factors associated with readiness for disaster response among Taiwanese hospital nurses. A cross-sectional study was conducted on 365 eligible and registered nurses at a medical centre in northern Taiwan. The Readiness for Disaster Responses Scale including four subscales: personal preparedness, self-protection, emergency response, and clinical management were used for assessment. Analyses were performed using multiple linear regression models. Our study results showed that the length of nursing work was positively associated with nurses' readiness for disaster responses (β = 0.28, p < .001). Nurses with a master's degree and working in intensive care units or emergency rooms had higher readiness for disaster responses (β = 0.13, p = .032; β = 0.14, p = .024) than those with a bachelor's degree and working in other units/specialties (i.e., outpatient department, operating rooms, etc.). Furthermore, nurses with previous disaster training were associated with greater readiness for disaster responses (β = 0.24, p < .001). This study findings indicate that the identified determinants of hospital nurses' readiness for disaster responses can be taken into consideration in the future recruiting of nurses for deployment to disaster response assistance and the designing of disaster training programmes specifically for nurses.

Relationship between emotional intelligence and disaster response self-efficacy: A comparative study in nurses

BACKGROUND

Nurses who constitute an important part of the health system play a critical role in all stages of disaster management, especially in providing care for disaster victims. It is essential for nurses to have adequate education and qualifications to reduce disaster-related mortality and morbidity rates in the community. The qualifications of nurses depend not only on their knowledge and skills but also on their emotional abilities such as empathy and stress management. Emotions can impact individuals' levels of self-efficacy in disaster response, and it may help explain the differences in self-efficacy among nurses.

OBJECTIVE

This study aimed to investigate the relationship between emotional intelligence and disaster response self-efficacy, and compare the scores between hospital nurses and National Medical Rescue Team nurses.

DESIGN

A cross-sectional design.

SETTINGS

This research was conducted at Bezmialem Foundation University Hospital and National Medical Rescue Team in Istanbul, Turkey.

PARTICIPANTS

This study included 565 nurses from two different institutions.

METHODS

A survey consisting of the Demographic Information Form, the Modified Schutte Emotional Intelligence Scale, and the Disaster Response Self-Efficacy Scale was administered to the nurses. The data collected from March to April of 2022 was analyzed using SPSS 25.0 program. The differences and relationships among variables were determined by using Chi-square tests, student's t-tests, Pearson correlation, and linear regression analyses.

RESULTS

Of the 565 participants, 219 (38.8%) were hospital nurses and 346 (61.2%) were NMRT nurses. NMRT nurses scored significantly higher in emotional intelligence (131.45 ± 6.15 versus 129.75 ± 6.01) and disaster response self-efficacy (80.71 ± 11.38 versus 77.77 ± 11.33) than hospital nurses (p < 0.05). In addition, emotional intelligence was found to be significantly and positively correlated to disaster response self-efficacy (r = 0.885, p < 0.05).

CONCLUSIONS

The emotional intelligence and disaster response self-efficacy were positively correlated, and both levels of NMRT nurses higher than hospital nurses. These findings suggest that healthcare organizations should take the emotional intelligence of nurses as an important means to improve their disaster response selfefficacy. It can improve the quality of disaster response to obtain well self-efficacy by developing the emotional intelligence of nurses.

Sociotechnical system design to support disaster intervention development teams

Teams are critical in developing effective responses to various disasters and crises. This study defines a new type of response team: a disaster intervention development team, charged with rapidly developing emergent and innovative interventions to aid disaster response. In this case study, we analyzed the SHIELD Enterprise, a disaster intervention development team that developed and deployed a diagnostic testing system for community surveillance and diagnosis to respond to the COVID-19 infectious disease outbreak. We conducted interviews with 27 team members to identify the work system barriers and facilitators they experienced and to analyze the influence on team performance to inform sociotechnical system design for future teams. We identified 215 barriers and 238 facilitators, which we inductively categorized into eight overarching groups, i.e., categories, that included ambiguity, team processes, technology, design and project requirements, knowledge and expertise, organization, task work and environment. Our findings led to eight sociotechnical system design principles to support future disaster intervention development teams.

Relationships are everything: The underpinnings of grassroots community action in the COVID-19 pandemic in Toronto

Most government emergency/pandemic response plans feature top-down decision making and communication strategies and a focus on 'hard' (physical) infrastructure. There is nothing about the importance of the ideas and communications originating from communities, the social infrastructure that supports their impact locally and their contribution to the central administration. In this study, we found that the 'soft' (social) infrastructure within communities and between communities and formal institutions is key to an inclusive and more equitable response to large-scale crises like the COVID-19 pandemic. Grassroots leaders in six Toronto neighbourhoods were interviewed between the first and second waves of the COVID-19 pandemic in Toronto about what helped or hindered community action. Three themes emerged: (1) Grassroots leaders and community organizations were able to act as key connection points in a two-way flow of information and resources with residents and service providers; (2) Grassroots leaders and groups were challenged to engage in this work in a sustained capacity without adequate resourcing; and (3) there was a disconnect between community-centred grassroots approaches and the City's emergency response. We conclude that there needs to be pre-disaster investment in community level planning and preparation that fosters two-way connections between all municipal emergency/disaster and pandemic preparedness plans and community-centred organizations and grassroots leaders working in marginalized communities.

The contributions of religious leaders in addressing food insecurity during the COVID-19 pandemic in the Philippines: A realist evaluation of the Rapid Emergencies and Disasters Intervention (REDI)

To address the unintended consequences of public health measures during the COVID-19 pandemic (e.g., emergency food insecurity, income loss), non-governmental organizations (NGOs) have partnered with diverse actors, including religious leaders, to provide humanitarian relief in resource-constrained communities. One such example is the Rapid Emergencies and Disasters Intervention (REDI), which is an NGO-led program in the Philippines that leverages a network of volunteer religious leaders to identify and address emergency food insecurity among households experiencing poverty. Guided by a realist evaluation approach, the objectives of this study were to identify the facilitators and barriers to effective implementation of REDI by religious leaders during the COVID-19 pandemic and to explore the context and mechanisms that influenced REDI implementation. In total, we conducted 25 virtual semi-structured interviews with religious leaders actively engaged in REDI implementation across 17 communities in Negros Occidental, Philippines. Interviews were audio recorded, transcribed, and thematically analyzed. Three main context-mechanism configurations were identified in shaping effective food aid distribution by religious leaders, including program infrastructure (e.g., technical and relational support from partner NGO), social infrastructure (e.g., social networks), and community infrastructure (e.g., community assets as well as a broader enabling environment). Overall, this study contributes insight into how the unique positionality of religious leaders in combination with organizational structures and guidance from a partner NGO shapes the implementation of a disaster response initiative across resource-constrained communities. Further, this study describes how intersectoral collaboration (involving religious leaders, NGOs, and local governments) can be facilitated through an NGO-led disaster response network.

Complex disaster response framework to reduce urban disaster vulnerability

Cities are vulnerable to a range of disasters that can occur simultaneously due to their complexity. Therefore, an effective disaster response plan is needed to reduce the disaster vulnerability of cities. In particular, evacuation route management is important for reducing the losses from a disaster. Efficient disaster response can be realized by searching for suitable evacuation routes and effective road network management. In this paper, we propose a disaster response framework based on a multilayered road network structure and evacuation routes based on our road network. The suggested road structure consists of three layers for the effective management of the network. An A* algorithm-based search for multiple evacuation routes under different conditions in response to an individual disaster on the configured road map provides a safe route for evacuees. As a result, the damage caused by disasters in urban areas can be ameliorated.

[Hospital disaster planning in south-western Germany. A survey of 214 clinics]

Background

Due to legal regulations in Germany, public acute and emergency (A&E) hospitals-along with responsible authorities, emergency medical services, and other institutions such as the state medical associations-are committed to participate in civil protection. This participation includes the need to create and update emergency plans for external and internal crises and to take part in disaster drills. In fact, so far there is only little literature to prove whether and to what extent hospitals fulfill their obligations on this topic.

Objectives

Using a standardized survey, the state of emergency planning in hospitals in Baden-Wuerttemberg was evaluated.

Materials and methods

Based on a listing provided by the Hospital Society of Baden-Wuerttemberg (BWKG), all 214 hospitals in Baden-Wuerttemberg were identified. The standardized questionnaire inquired about specific characteristics of the emergency plan, the availability and knowledge of this plan by the hospital workforce and other local institutions that take part in civil protection and, finally, participation in disaster drills were queried.

Results

Of the 214 hospitals in Baden-Wuerttemberg, 135 (63%) provided information using the questionnaire. Except for one hospital, all other clinics indicated having a special emergency plan ready. In most cases (79.3%), both external (e.g., mass casualty incidents) and internal (e.g., fire, failure of technical equipment) crises are covered. In the vast majority of cases (94%), the hospitals also indicated that they regularly update their emergency plan, whereby the frequency of updates varied markedly. Three quarters of the hospitals said that they also regularly simulate the use of the emergency plan in disaster drills. In two thirds of the cases, external forces such as emergency medical services or the fire department also take part in these drills along with the hospitals themselves. In some cases, knowledge gained from the drills was incorporated into the emergency plan or led to improvements in staff training.

Conclusions

The willingness of public hospitals to establish comprehensive disaster planning and to take part in related drills seems to have improved noticeably in recent years. However, there is still the need for improvement in keeping the concepts up to date at some hospitals. Especially smaller hospitals showed deficits in emergency planning, particularly concerning preparedness for internal crises, resulting from failure of technical equipment. More regular drills should be used to test existing concepts and to familiarize employees with the processes on a routine basis.

"COVID knocked me straight into the dirt": perspectives from people experiencing homelessness on the impacts of the COVID-19 pandemic

Background

People experiencing homelessness are uniquely susceptible and disproportionately affected by the impacts of the COVID-19 pandemic. Understanding context-specific challenges, responses, and perspectives of people experiencing homelessness is essential to improving pandemic response and mitigating the long-term consequences of the pandemic on this vulnerable population.

Methods

As part of an ongoing community-based participatory research study in partnership with a homeless service organization in Indiana, semi-structured interviews were conducted with a total of 34 individuals experiencing homelessness between January and July 2021. Guided by the NIMHD Health Disparities Research Framework, which builds on the socio-ecological model, data was thematically coded using Nvivo12 qualitative coding software and themes were organized by levels of influence (individual, interpersonal, community, societal) and domains of influence (biological, behavioral, physical/built environment, sociocultural environment, health care system).

Results

Narratives revealed numerous and compounding factors affecting COVID-19 risks and health outcomes among people experiencing homelessness across all levels and domains of influence. At the individual level, people experiencing homelessness face unique challenges that heightened their susceptibility to COVID-19, including pre-existing physical and mental health conditions, substance use and behavioral health risks, socioeconomic precarity, and low health literacy and COVID-related knowledge. At the interpersonal level, poor communication between people experiencing homelessness and service providers led to limited understanding of and poor compliance with COVID safety measures. At the community level, closures and service disruptions restricted access to usual spaces and resources to meet basic needs. At a policy level, people experiencing homelessness were disregarded in ways that made pandemic relief resources largely inaccessible to them.

Conclusions

Our findings reveal important and mitigable issues with ongoing pandemic response efforts in homeless populations through direct, first-hand accounts of their experiences during COVID-19. These insights offer opportunities for multilevel interventions to improve outreach, communication, and impact mitigation strategies for people experiencing homelessness. This study highlights the importance of centering the voices of vulnerable communities to inform future pandemic response for homeless and other underserved and marginalized populations.

Assessment of an evacuation shelter program for people with access and functional needs in Monroe County, Florida during Hurricane Irma

This case study presents an evaluation framework to assess the facilitating and constraining factors that influenced the emergency response, operation, and management of a Special Needs Shelter Program in Monroe County, Florida during Hurricane Irma in 2017. A qualitative analysis of key documents and discussions with agencies directly involved in the Monroe County Special Needs Shelter Program was used to assess four major emergency response processes: notifications and communications, evacuation and transportation, sheltering, and interagency coordination. A critical cross-cutting theme emerged, which was a lack of a common definition for populations with "special needs" across different agencies resulting in uncertainties about who should be admitted to the Special Needs Shelter and have access to their services. We generate public health and emergency management lessons to inform future adaptation, preparedness, and response plans to extreme weather events for populations with access and functional needs in Monroe County and Florida's coastal communities more broadly.

Exposure patterns among Coast Guard responders to the Deepwater Horizon Oil Spill: A latent class analysis

Background

The Deepwater Horizon Oil Spill was an environmental crisis for which multiple groups, including the United States Coast Guard (USCG), provided emergency response services. A cohort of 5,665 USCG oil spill responders completed postdeployment surveys eliciting information on a variety of topics, including oil spill-related exposures and experiences. Our objective was to determine the most common exposure patterns among USCG responders.

Methods

We used latent class analysis based on six indicator variables reflecting different aspects of the responders' experiences: exposure to oil, exposure to engine exhaust fumes or carbon monoxide, hand sanitizer use, sunblock use, mosquito bites, and level of anxiety. We validated our interpretation of these latent classes using ancillary variables.

Results

The model distinguished four distinct exposure profiles, which we interpreted as "low overall exposure" (prevalence estimate = 0.18), "low crude oil/exhaust and moderate time outdoors/anxiety (prevalence estimate = 0.18), "high crude oil/exhaust and moderate time outdoors/anxiety" (prevalence estimate = 0.25), and "high overall exposure" (prevalence estimate = 0.38). The validation analysis was consistent with our interpretation of the latent classes.

Conclusions

The exposure patterns identified in this analysis can help inform future studies of the health impacts of exposure mixtures among USCG oil spill responders.

Risk communication and community engagement during COVID-19

In today's information age, both excess and lack of information can cause a disaster. COVID-19 pandemic not only highlighted the significance of risk communication but also pointed out several unintended and distressing consequences due to information gaps and miscommunications. Despite facing a common threat, the local communities suffered differential impacts during the pandemic. This paper classifies the nature of risk communications experienced across different countries into three categories, namely: inadequate, ideal, and infodemic risk communication that influenced the local perceptions and responses. It further argues that inadequately planned risk communications tend to create new risks and compromise the efforts towards managing a disaster. As global risks are responded locally, there is a need for more inclusive and engaging risk communication that involves communities as responsible stakeholders who understand, plan, and respond to risks to increase their propensity for resilience during disasters and crisis situations.

Critical gaps and implications of risk communication in the global agreements-SFDRR, SDGs, and UNFCCC: 3 select case studies from urban areas of tropics in South Asia

There has been a consistent rise in urban disasters, particularly in developing countries located in tropical areas. Among various challenges of disaster risk management and climate change impacts, it is noted that most residents are poorly informed about their risk exposure or apposite response. The paper is based on the premise that one important cause for this gap is inadequate emphasis on risk communication at different levels of planning and agreements. Accordingly, it highlights some important gaps in the risk communication across international agreements including Sendai Framework for Disaster Risk Reduction (SFDRR), Sustainable Development Goals (SDGs), and United Nations Framework Convention on Climate Change (UNFCCC), and evaluates their impacts at the local level. It brings three selected urban case studies located in the tropical areas of the South Asia region that illustrate gaps in risk communication that result in enhanced vulnerability and deviations in response. The findings are based on secondary data and literature focusing on global agreements, risk communication, and disaster response. The paper argues that even though global strategies address urban risks, the fragmented nature of risk communication results in poor response and contributes to losses that occur in disasters. Three critical gaps noted in risk communication include (i) it not prioritized at different levels, (ii) inadequate structures to measure its impacts and stakeholders inclusiveness, and (iii) indifference to cultural diversity and integration. Further, it is suggested that there is a need to redefine risk communication at the global scale that extends beyond warning generation and considers multiple factors influencing response including interlinked vulnerabilities and variations in perceptions emerging from varied geographical, socio-cultural, economic, and political processes.

Clinical and organizational framework of repurposing pediatric intensive care unit to adult critical care in a resource-limited setting: Lessons from the response of an urban general hospital to the COVID-19 pandemic

PURPOSE

We aim to describe the action plan and clinical results of a COVID-19 unit for adult patient care in units intended for critically ill children, proposing a clinical/administrative framework.

METHODS

We reviewed the preparedness of the PICU team before the surge of cases of COVID-19 and the organizational/administrative issues to increase critical beds in a six-bed PICU allocated to adult critical care in a government-funded general hospital in Latin America. We analyzed the prospectively collected administrative/clinical data of severe COVID-19 cases admitted to PICU during the peak of the first wave of the pandemic.

RESULTS

We describe a 6-step preparedness plan: recruitment and education, admission criteria, children diversion, team hierarchy, and general and respiratory equipment. The 6-bed PICU was allocated to adult care for 20 weeks, progressively increasing capacity to a 23-bed dedicated COVID-19 unit managed by the PICU team. A six-block bed organizational units were implemented, and personnel increased from 40 to 125 healthcare workers in 24 h shifts. COVID-19 incidence in personnel was 0.5/1000 workdays. One hundred thirty-six patients were admitted, median age 59 (51,65) years old, 68% were male, and 63% had P/F ≤ 100. In addition, 48% received mechanical ventilation, the median length of stay was 7 (3,17), and in-hospital mortality was 15%.

CONCLUSIONS

We propose an organizational framework for the role of PICU in the hospital action plan to increase adult critical beds. The cohort of patients admitted to a PICU repurposed as a COVID-19 ICU had good outcomes. These data are valuable to plan coordinated actions of the healthcare system for future scenarios.

Observations from the emergency management of dialysis patients evacuated from the US Virgin Islands to Puerto Rico following hurricane Irma

Two category 5 hurricanes, Irma and Maria, arrived in the Caribbean in September 2017 in rapid succession. On September 6, Irma devastated the islands of St. Thomas and St. John, in the Virgin Islands of the United States (USVI). Most medical infrastructure was damaged, including hemodialysis facilities, paralyzing dialysis operations. After Irma’s landfall, Puerto Rico served as a safehaven for thousands of displaced and repatriated persons from the impacted islands. These included a cohort of 129 hemodialysis patients evacuated from St. Thomas, USVI to San Juan, Puerto Rico from September 9−11, 2017. The hemodialysis patients arrived first at hotels in San Juan and were then transferred to a Special Needs Shelter, run by the Commonwealth of Puerto Rico and located in the Puerto Rico Convention Center. With the imminent arrival of Hurricane Maria, most patients were evacuated on September 19 to a special needs shelter on the campus of the Florida International University, in Miami, Florida. While in San Juan, hemodialysis treatments were provided by local nephrologists working with local hemodialysis centers. Here, we describe the challenges and the emergency management actions taken to ensure continuity of care, including providing dialysis, general medical care, shelter, food and transportation for USVI dialysis patients during their stay in San Juan, Puerto Rico. We describe here the experiences of federal and host state/territorial officials in the special needs shelter, in the context of the state/territorial and federal response to disasters, in order to provide ideas about challenges, solutions, and approaches to coordinating care for dialysis patients evacuated from a disaster.

"A shovel or a shopping cart": lessons from ten years of disaster response by a student-led volunteer group

Recent years have seen growing interest in enabling volunteers to play a more pronounced role in disaster response, and yet efforts to systematically analyse this crisis volunteer action, particularly among young people, have been surprisingly limited. This study examines the case of the Student Volunteer Army (SVA) in Aotearoa New Zealand, a student-led group which over the space of a decade has responded to multiple disasters, including earthquakes, floods, fires, a terrorist attack and the Covid-19 pandemic. Drawing on in-depth interviews, our analysis compares the practices adopted by the SVA in response to these different crises and identifies how members and supporters of the group have come to understand its capabilities, limitations, and conditions for effective operation. We present a framework of cross-cutting lessons of "why", "who", "when", "what" and "how" and demonstrate the ways they have been built upon for each new disaster mobilisation. In distilling, the key lessons of a youth-led crisis volunteer group that has mobilised for a spectrum of disasters, this paper contributes to theoretical understandings of how groups at a local level learn after sequential disasters, and the conditions and considerations that enable such groups to effectively-and repeatedly-"meet a need" in disaster response.

Preparing for and responding to sexual and reproductive health in disaster settings: evidence from Fiji and Tonga

BACKGROUND

Pacific Island countries are vulnerable to disasters, including cyclones and earthquakes. Disaster preparedness is key to a well-coordinated response to preventing sexual violence and assisting survivors, reducing the transmission of HIV and other STIs, and preventing excess maternal and neonatal mortality and morbidity. This study aimed to identify the capacity development activities undertaken as part of the SPRINT program in Fiji and Tonga and how these enabled the sexual and reproductive health (SRH) response to Tropical Cyclones Winston and Gita.

METHODS

This descriptive qualitative study was informed by a framework designed to assess public health emergency response capacity across various levels (systems, organisational, and individual) and two phases of the disaster management cycle (preparedness and response). Eight key informants were recruited purposively to include diverse individuals from relevant organisations and interviewed by telephone, Zoom, Skype and email. Template analysis was used to examine the data.

FINDINGS

Differences in the country contexts were highlighted. The existing program of training in Tonga, investment from the International Planned Parenthood Federation (IPPF) Humanitarian Hub, the status of the Tonga Family Health Association as the key player in the delivery of SRH, together with its long experience of delivering contract work in short time-frames and strong relationship with the Ministry of Health (MoH) facilitated a relatively smooth and rapid response. In contrast, there had been limited capacity development work in Fiji prior to Winston, requiring training to be rapidly delivered during the immediate response to the cyclone with the support of surge staff from IPPF. In Fiji, the response was initially hampered by a lack of clarity concerning stakeholder roles and coordination, but linkages were quickly built to enable a response. Participants highlighted the importance of personal relationships, individuals' and organisations' motivation to respond, and strong rapport with the community to deliver SRH.

DISCUSSION

This study highlights the need for comprehensive activities at multiple levels within a country and across the Pacific region to build capacity for a SRH response. While the SPRINT initiative has been implemented across several regions to improve organisational and national capacity preparedness, training for communities can be strengthened. This research outlines the importance of formalising partnerships and regular meetings and training to ensure the currency of coordination efforts in readiness for activation. However, work is needed to further institutionalise SRH in emergencies in national policy and accountability mechanisms.

Intermodal Humanitarian Logistics Using Unit Load Devices

Intermodal freight transportation facilitates today's global trade. The benefits of intermodal freight transportation have been studied and are more observable in commercial logistics; however, the potential benefits of humanitarian logistics have not been thoroughly investigated. This research aims to present a resilient transportation framework by modeling intermodal transportation utilizing interoperable loading devices during disaster responses. We developed an integer programming model based on a time-space network by considering route and vehicle availabilities that are allowed to change with time. We consider vehicles with varying capacities in three transportation modes (i.e., ground, maritime, and air). The contribution of this study is threefold: (1) Two compatible unit load devices are proposed for humanitarian logistics; (2) a mathematical model that includes integer variable representation for vehicle fleets in different transportation modes is developed; and (3) intermodal transportation is compared with single-mode transportation using a real-life dataset. Our main results are as follows: In terms of cost, intermodal transportation is effective when demand occurs in consecutive periods and response time is short. Inventory is held more in intermodal transportation when it is cost-effective to use transportation modes with large capacities. Thus, the benefits of the responsiveness of intermodal transportation outweigh the costs of mode interchange and inventory holding for sudden-onset disasters where quick responses are needed within a short time.

Homelessness during COVID-19: challenges, responses, and lessons learned from homeless service providers in Tippecanoe County, Indiana

Background

The COVID-19 pandemic laid bare some of the United States’ most devastating health and social inequities faced by people experiencing homelessness. Homeless populations experience disproportionate rates of underlying health conditions, stigma and marginalization that often disenfranchise them from health and social services, and living conditions that potentiate the risk of COVID-19 transmission and adverse outcomes.

Methods

Guided by the socio-ecological model, this community-based participatory research study examined the impacts of the COVID-19 public health crisis on people experiencing homelessness in Tippecanoe County, Indiana, and the ways in which homeless service providers prepared for, experienced, and responded to the pandemic. Eighteen (18) semi-structured interviews were conducted with representatives of 15 community-based organizations, including shelters and other homeless service providers.

Results

Qualitative content analysis revealed myriad challenges at the individual and interpersonal levels faced by people experiencing homelessness as a result of the pandemic, and multilevel responses for COVID-19 impact mitigation in this community. Many of the emergency measures put in place by homeless service providers in Tippecanoe County, Indiana created opportunities for innovative solutions to longstanding challenges faced by homeless populations that are informing better service delivery moving forward, even beyond the COVID-19 pandemic.

Conclusions

Community-based organizations, including homeless shelters, are uniquely qualified to inform pandemic response and disaster risk mitigation in order to respond appropriately to the specific needs of people experiencing homelessness. The lessons learned and shared by homeless service providers on the frontline during the COVID-19 pandemic have important implications to improve future disaster response for homeless and other vulnerable populations.

Medical students as disaster volunteers: A strategy for improving emergency department surge response in times of crisis

Disasters resulting in mass casualty incidents can rapidly overwhelm the Emergency Department (ED). To address critical manpower needs in the ED’s disaster response, medical student involvement has been advocated. Duke-National University of Singapore Medical School is in proximity to Singapore General Hospital and represents an untapped manpower resource. With appropriate training and integration into ED disaster workflows, medical students can be leveraged upon as qualified manpower. This review provides a snapshot of the conceptualization and setting up of the Disaster Volunteer Corps – a programme where medical students were recruited to receive regular training and assessment from emergency physicians on disaster response principles to fulfil specific roles during a crisis, while working as part of a team under supervision. We discuss overall strategy and benefits to stakeholders, emphasizing the close symbiotic relationship between academia and healthcare services.

Spatial and temporal distribution of surface water contaminants in the Houston Ship Channel after the Intercontinental Terminal Company Fire

BACKGROUND

The fire at the Intercontinental Terminals Company (ITC, Deer Park, La Porte, TX, USA) from March 17 to 20, 2019 resulted in substantial releases of chemical contaminants to the environment, including the surface waters of the Houston Ship Channel.

OBJECTIVE

To characterize spatial and temporal trends, as well as potential human health risks, from these releases.

METHODS

Out of 433 substances with available data, seven were selected for analysis: benzene, toluene, ethylbenzene, xylenes, oil and grease, suspended solids, and total petroleum hydrocarbons. Spatial and temporal concentration trends were characterized, and hazard quotients and cancer risks were calculated to estimate the potential for human health impacts from these contaminants.

RESULTS

Temporal analysis showed presence of these chemical contaminants in water immediately after the event; their concentrations dissipated substantially within 4 weeks. The spatial distribution of contaminants indicated the highest concentrations in the waterways within about 1 km of the ITC. The greatest potential human health risks stemmed from presence of benzene.

SIGNIFICANCE

A short-term but substantial spike in the concentrations of a number of hazardous contaminants occurred near the incident, with concentrations returning to apparent baseline levels within 1 month likely due to a combination of volatization, dilution and degradation.

The next big earthquake may inflict a multi-hazard crisis - Insights from COVID-19, extreme weather and resilience in peripheral cities of Israel

The occurrence of a natural disaster in an area already coping with an epidemic, constitutes a multi-hazard event. Such events are more likely than ever during the ongoing COVID-19 pandemic. In regions that seasonally experience extreme-weather disasters, such multi-hazard crises are imminent. People living along the Dead Sea Fault and in the Negev are used to harsh weather conditions and to the hardship of living in isolation. While self-reliance and community-support are often the norm in the daily life of residents in in peripheral communities, in an emergency they may be crucial for survival. Worldwide remote communities with limited response and medical infrastructure and resources may struggle to cope with the aftermath of an earthquake while potentially coping with a concurrent epidemic or extreme weather. In this work we focus on the effect of concurring disasters and seasonal stressors. In particular we discuss how various disasters would affect the Covid-19 infection rate, and we demonstrate that in Israel's periphery cities, heat-stress is a consistent and significant seasonal stressor that would hamper emergency and recovery operations. We also suggest that transient tourist population in these remote cities is expected to burden local emergency efforts and facilities. A seasonal over burden parameter is proposed to describe how seasonal tourism and weather conditions enhance the hardship and risk in a multi-hazard situation. A case study shows that high-resolution spatial analysis of risk and preparedness together with a temporal analysis of seasonal effects, may be used to detect specific neighborhoods with high or low resilience and capacity to cope with disasters. Our work demonstrates the need for spatial and temporal, multi-hazard analysis for improving local resilience and emergency plans in periphery cities and communities exposed to seasonal harsh weather.

"Helping fill that gap:" a qualitative study of aging in place after disaster through the lens of home-based care providers

Background

During a disaster, home-based care fills the critical need for continuation of health care. Home-based care is intended to function using existing care delivery models, continuing to provide care for patients wherever they are located, including in shelters and hotels. Home-based care providers are often the closest in contact with their patients —seeing them in place, even throughout a disaster— through which they develop a unique insight into aging in place during a disaster. The purpose of this study was to identify individual and community-level support needs of older adults after a disaster through the lens of home-based care providers.

Methods

Using qualitative inquiry, five focus groups were conducted with home-based care providers (n = 25) who provided in-home care during Hurricane Irma and Hurricane Harvey. Participants were identified by contacting home health agencies listed in an open-source database of agencies participating in Centers for Medicare and Medicaid Services programs. Data were coded using an abductive analytic approach, and larger themes were generated in light of existing theory.

Results

The results were distilled into eight themes that related to the importance of community and family, informal and formal supports throughout the disaster management cycle, maintaining autonomy during a disaster, and institutional and systemic barriers to obtaining assistance.

Conclusions

In this study, home-based care providers described the challenges aging adults face in the response and recovery period after a large-scale disaster including maintaining continuity of care, encouraging individual preparedness, and accessing complex governmental support. Listening to home-based care providers offers new and important insights for developing interventions to address social and health needs for older adults aging in place after a large-scale disaster.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02159-0.

Working short and working long: can primary healthcare be protected as a public good in Lebanon today?

In this commentary we propose four questions to be addressed while building a meaningful public primary healthcare response in Lebanon today. These questions emerge from two imperatives: the necessity to consider both short- and longer-term struggles in a context of protracted conflict and the need to protect public health as a public good whilst the public Primary Healthcare Network (PHCN) is facing the Covid19 pandemic. In order to identify how these questions are related to the need to be working short and long, we look at the imprints left by past and present shocks. Profound shocks of the past include the Lebanese civil war and the Syrian refugee crisis. We analyse how these shocks have resulted in the PHCN developing resilience mechanisms in order to ensure a space for healthcare provision that stands public in Lebanon today. Then, we consider how two present shocks -- the economic breakdown and the blast of ammonium nitrate in Beirut port -- are affecting and threatening the progress made by the PHCN to ensure that primary healthcare remains a public good, a fragile space acquired with difficulty in the past half century. We identify what questions emerge from the combined consequences of such traumas, when the immediate constraints of the present meet the impediments of the past. We consider what such questions mean more broadly, for the people living in Lebanon today, and for the PHCN ability to respond to the Covid 19 pandemic in a relevant way. Our hypothesis is that in a protracted conflict, such as the one defining the circumstances of Lebanon now, public access to primary healthcare might persist for the people as one safeguard, in which social and moral continuity can be anchored to protect a sense of public good.

Developing and implementing an infection prevention and control program for a COVID-19 alternative care site in Philadelphia, PA

Background

On March 27, 2020, the city of Philadelphia was given permission by Temple University to convert the Liacouras Center gymnasium to an alternate care site (ACS) to treat low-acuity COVID-19 patients. ACSs, especially those created to specifically care for infectious patients, require a robust infection prevention and control (IPC) program.

Methods

The IPC program was led by a physician and nurse partnership, both of whom had substantial experience developing IPC programs in US and low-resource settings. The IPC program was framed on a previously described conceptual model commonly referred to as the “4S's”: Space, Staff, Stuff, and Systems.

Results

The gymnasium was transformed into red, yellow, and green infection hazard zones. The IPC team trained 425 staff in critical IPC practices and personal protective equipment standards. Systems to detect staff illness were created and over 3,550 staff health screening surveys completed.

Discussion

Use of existing guidance and comprehensive facility and patient management assessments guided the development of the IPC program. Program priorities were to keep staff and patients safe and implement procedures to judiciously use limited resources that affect infection transmission.

Conclusion

Planning, executing, and evaluating IPC standards and requirements of an ACS during a pandemic requires creative and nimble strategies to adapt, substitute, conserve, reuse, and reallocate IPC space, staff, stuff, and systems.

US Hospital Preparedness to Manage Unidentified Individuals and Reunite Unaccompanied Minors with Family Members During Disasters: Results from a Nationwide Survey

Unaccompanied minors and other unidentified individuals may present to hospitals during disasters and require reunification with family. Hospital preparedness for family reunification during disasters has never been assessed. We sent members of the Association of Healthcare Emergency Preparedness Professionals an anonymous online survey in July and August 2019 to assess their hospital's reunification readiness during a disaster. Scores on preparedness to manage unidentified patients were calculated based on 21 indicators, each with a score of 0 or 1. A multivariate linear regression was conducted to delineate factors associated with higher preparedness scores. In total, 88 individuals participated (response rate = 33.4%). All agreed that reunification preparedness is important, but far fewer (χ² = 33.8, P < .001) believed their hospital was prepared to reunify unidentified individuals during a disaster (n = 58, 65.9%). Most (n = 56, 63.6%) had at least some written reunification plan. Preparedness scores ranged from 0 to 21 (mean = 8.0, standard deviation = 7.3). Predictors of preparedness included having a pediatrician on the hospital disaster planning committee, conducting a disaster exercise that simulated an unaccompanied minor scenario, and implementing the 2018 American Academy of Pediatrics Reunification Planning Tool. Findings from this study indicate that many US hospitals are not prepared to reunify unaccompanied minors or other separated family members during a disaster. The planning tool is a free resource that hospitals can use to improve their hospital reunification plans. Hospitals should prioritize development of reunification plans to ensure rapid response during a future event. Use of the planning tool can aid in development and improvement of these plans.

Innovating at the human-technology interface in disasters and disease outbreaks

Disasters and disease outbreaks have long been a catalyst for innovative applications of emerging technologies. The urgent need to respond to an emergency leads to resourceful uses of the technologies at hand. However, the best and most cost-effective use of new technologies is to prevent disease and improve resilience. In this paper, the authors present a range of approaches through which both opportunities can be grasped. Global connectedness enables more data to be collected and processed in emergencies, especially with the rise of open-source data, including social media. In general, the poorest and most remote populations are most vulnerable to disaster. However, with smaller, faster, smarter, cheaper and more connected technology, reliable, efficient, and targeted response and recovery can be provided. Initially, crowdsourcing was used to find people, map affected areas, and determine resource allocation. This led to the generation of an overwhelming amount of data, and the need to extract valuable information from that data in a timely manner. As technology evolved, organisations started outsourcing many tasks, first to other people, then to machines. Since the volume of data generated outpaces human capacity, data analysis is being automated using artificial intelligence and machine learning, which furthers our abilities in predictive analytics. As we move towards prevention rather than remediation, information collection and processing must become faster and more efficient while maintaining accuracy. Moreover, these new strategies and technologies can help us to move forwards, by integrating layers of human, veterinary, public, and environmental health data for a One Health approach.

Are we there yet? The transition from response to recovery for the COVID-19 pandemic

There is no corner of the planet that has not been impacted by the rapid spread of the novel coronavirus, COVID-19. While the COVID-19 pandemic has already had far-reaching socioeconomic consequences commonly associated with natural hazards (such as disruption to society, economic damage, and loss of lives), the response of governments around the world has been unparalleled and unlike anything seen before. Governments are faced with a myriad of multi-dimensional effects of the pandemic, including direct impacts on public health systems and population health and indirect socioeconomic effects including disruption to every single sector of the economy and mass unemployment. There is, additionally, the growing realisation that the timescale associated with this crisis may permanently change the very foundations of societies 'normal' day-to-day life. As the world transitions to recovering from COVID-19, those developing that recovery need support in adjusting and improving their policies and measures. The situation seems dire, the stakes are high. Literature about the transition between the response and recovery phase in relation to pandemics is scarce. Further complication is that the pandemic will not allow countries to simply transition to the full-scale recovery, instead, a rebound from recovery to response phase is expected for a certain period until the immunization is in place. Pandemics indeed force us to think beyond typical emergency management structures; the cycles of the disaster risk management in the case of biological and other natural hazards are not exactly the same and no one-size-fits-all approach may be used. Still, some parallels may be drawn with the efforts to combat natural hazards and some lessons may be used from previous and the current pandemic. Based on these experiences and reflections, this paper provides a set of policy directions to be considered during the transition towards, as well as throughout, this transition phase. It is suggested that meeting this global, multi-dimensional, and complex challenge will require considerable international collaboration (even convention) and macro-scale changes to global and national policies. The recovery issues are mainly going to be dominated by politics, economics and social science. Necessary for an effective recovery, the pandemic response needs to be a holistic response, combined with an improved data ecosystem between the public health system and the community. We should also view this outbreak and our response to it as an opportunity to learn lessons and reaffirm our universal commitment to sustainable development and enhancing wellbeing around the world.

A New Paradigm for Addressing Health Disparities in Inner-City Environments: Adopting a Disaster Zone Approach

Inner cities are characterized by intergenerational poverty, limited educational opportunities, poor health, and high levels of segregation. Human capital, defined as the intangible, yet integral economically productive aspects of individuals, is limited by factors influencing inner-city populations. Inner-city environments are consistent with definitions of disasters causing a level of suffering that exceeds the capacity of the affected community. This article presents a framework for improving health among inner-city populations using a multidisciplinary approach drawn from medicine, economics, and disaster response. Results from focus groups and photovoice conducted in Milwaukee, WI are used as a case study for a perspective on using this approach to address health disparities. A disaster approach provides a long-term focus on improving overall health and decreasing health disparities in the inner city, instead of a short-term focus on immediate relief of a single symptom. Adopting a disaster approach to inner-city environments is an innovative way to address the needs of those living in some of the most marginalized communities in the country.

Characterization of initial North American pediatric surgical response to the COVID-19 pandemic

INTRODUCTION

The impact of COVID-19 pandemic on pediatric surgical care systems is unknown. We present an initial evaluation of self-reported pediatric surgical policy changes from hospitals across North America.

METHODS

On March 30, 2020, an online open access, data gathering spreadsheet was made available to pediatric surgeons through the American Pediatric Surgical Association (APSA) website, which captured information surrounding COVID-19 related policy changes. Responses from the first month of the pandemic were collected. Open-ended responses were evaluated and categorized into themes and descriptive statistics were performed to identify areas of consensus.

RESULTS

Responses from 38 hospitals were evaluated. Policy changes relating to three domains of program structure and care processes were identified: internal structure, clinical workflow, and COVID-19 safety/prevention. Interhospital consensus was high for reducing in-hospital staffing, limiting clinical fellow exposure, implementing telehealth for conducting outpatient clinical visits, and using universal precautions for trauma. Heterogeneity in practices existed for scheduling procedures, implementing testing protocols, and regulating use of personal protective equipment.

CONCLUSIONS

The COVID-19 pandemic has induced significant upheaval in the usual processes of pediatric surgical care. While policies evolve, additional research is needed to determine the effect of these changes on patient and healthcare delivery outcomes.

LEVEL OF EVIDENCE

III.

Broadening the Mandate of the Incident Command System to Address Community Mental and Behavioral Health Effects as Part of the Federal Response to Disasters

PURPOSE OF REVIEW

In the United States, the Federal Incident Command System (ICS) directs response to major oil spills. Its initial imperative is to prevent immediate impacts on human health and safety. Subsequently, the ICS primarily turns its attention to environmental concerns, including considering vulnerable ecosystems. There is a growing body of evidence that disasters such as major oil spills lead to adverse psychosocial effects; yet, preventing such effects has not been formally incorporated into ICS disaster mitigation considerations.

RECENT FINDINGS

Community mental and behavioral effects are increasingly recognized as a significant impact of disasters. Standardized ecosystem analytical frameworks are key to ICS responses to its mandate for environmental protection. Similar frameworks have only begun to be developed for mental and behavioral effects. Providing the ICS with a formal mandate would likely lead to the prevention of community mental and behavioral effects being more systematically incorporated into ICS disaster responses.

Hospital preparedness for mass critical care during SARS-CoV-2 pandemic

Mass critical care caused by the severe acute respiratory syndrome corona virus 2 pandemic poses an extreme challenge to hospitals. The primary goal of hospital disaster preparedness and response is to maintain conventional or contingency care for as long as possible. Crisis care must be delayed as long as possible by appropriate measures. Increasing the intensive care unit (ICU) capacities is essential. In order to adjust surge capacity, the reduction of planned, elective patient care is an adequate response. However, this involves numerous problems that must be solved with a sense of proportion. This paper summarises preparedness and response measures recommended to acute care hospitals.

The Role of Telemental Health, Tele-consultation, and Tele-supervision in Post-disaster and Low-resource Settings

PURPOSE OF REVIEW

The goal of this paper was to review recent literature and provide recommendations regarding the use of telemental health, with a focus on tele-consultation and tele-supervision in post-disaster and low-resource settings, including the impact of COVID-19.

RECENT FINDINGS

The latest research on mental health needs in low-resource settings has identified a high need for mental health services for difficult-to-reach and underserved populations. Research on tele-consultation and tele-supervision was reviewed and found that tele-consultation and tele-supervision to be an effective modality for insuring quality mental health care delivery in low-resource settings. Additionally, two case studies were included which illustrate the use of both tele-consultation and tele-supervision in low-resource low- and middle-income settings. The paper concludes that tele-consultation and tele-supervision hold the promise to narrow the gap in quality mental health services in low-resource settings so often impacted by disaster and conflict. The authors recommend that telemental health training be developed that specifically enhances consultants' and supervisors' skills in tele-consultation and tele-supervision.

Augmenting Critical Care Capacity in a Disaster

A health care facility must develop a comprehensive disaster plan that has a provision for critical care services. Mass critical care requires surge capacity: augmentation of critical care services during a disaster. Surge capacity involves staff, supplies, space, and structure. Measures to increase critical care staff include recalling essential personnel, using noncritical care staff, and emergency credentialing of volunteers. Having an adequate supply chain and a cache of critical care supplies is essential. Virtual critical care or tele-critical care can augment critical care capacity by assisting with patient monitoring, specialized consultation, and in pandemics reduces staff exposure.

Clinical Tools for Working Abroad with Migrants

There are an estimated 68.5 million displaced persons worldwide, about one-half of whom are under the age of 18 years. The health needs of migrants are complex and dynamic along their journey. When structuring health care services for migrants abroad, there is not a one-size-fits-all approach and programming must be adaptable, practical, relevant, sustainable, and ideally integrated into the host country's health care system. In this article, we the examine clinical and public health priorities for migrant health care abroad and practical resources for health care professionals who wish to put their ideals into practice in the field.

Improving the science and evidence base of disaster response: a policy research study

Background

In order to elicit the knowledge, experience, and attitudes of individuals involved in disaster response with regard to evidence-based best practices, Evidence Aid and its institutional partners, Georgetown University and the Uniformed Services University of the Health Sciences, carried out a Policy Delphi study in 2015–2016.

Methods

Purposive and snowball methods were used to select study participants. The Delphi study comprised two rounds of iterative questions, with the questionnaires completed online. In addition, participants at the Evidence Aid conference in November 2016 discussed the findings in focus groups. Excel was used to analyze the quantitative data and Glaser and Strauss (1967) to analyze the qualitative data.

Results

Thirty-six participants responded to the first round of the study, 165 responded to the second round, and 30 participated in the focus group discussions. The salient findings include 1) ensuring that all key stakeholders are engaged in planning for and responding to disasters in a collaborative, coordinated manner—including local community members; 2) using, insofar as possible, evidence-based responses; 3) increasing and strengthening research to ensure that such data are available; and 4) addressing ethical, legal and social issues throughout the planning, immediate response, and post-disaster periods.

Conclusions

Recent humanitarian disasters, due to natural and man-made hazards or a combination of the two, reinforce the need for more effective, efficient, humane responses at the local, national and international levels. This study has yielded findings that can be used to strengthen planning and response by taking into account, where possible, evidence based on research that has been carried out with the engagement of community members and with support by key stakeholders. The most effective means of facilitating the development and implementation of consistent, coordinated policies and practices might be for the United Nations Office for Disaster Risk Reduction to take the lead in engaging key organizations in the required discussions and collaborations.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4102-5) contains supplementary material, which is available to authorized users.

Mental health workers perceptions of disaster response in China

BACKGROUND

The post-disaster mental health crisis intervention (MHCI) system in China remains immature and unsystematic. We aim to report the perceptions of a large sample of MHCI workers and government administrators and provide recommendations for developing a national mental health disaster response management plan in China.

METHODS

An in-depth qualitative study was conducted, collecting data from 20 focus-group discussions and 25 key stakeholder interviews. These recruited participants who had been involved in different types of disaster rescue across 7 provinces/cities where disasters have recently occurred. We used thematic analysis to analyze the data and relevant findings were extracted for policy recommendation.

RESULTS

Mental health workers' perspectives were examined in detailed according to four core themes: forms of organization, intervention pathway, intervention strategy and technique, and public health information. Post-disaster MHCI should be approached in teams that are integrated with emergency medicine systems, and be led by unified command management. All levels of local health and family planning commission should prepare post-disaster MHCI work plans and build response teams/emergency centres. Future training for MHCI workers should focus on: building a sense of trust within the team; clarifying each member's role; strengthening the screening, assessment and referrals training for psychological professionals; and providing psychological intervention training for Chinese psychiatrists. It is necessary to set up guiding principles for disaster research ethics, mental health rehabilitation and media interaction.

CONCLUSIONS

Through exploring and analyzing the perceptions of current disaster response mental health workers and government administrators, our findings provide essential recommendations for developing a national to county level post-disaster MHCI emergency management plan and can guide the formulation of relevant laws and regulation in China.

Leveraging Technology in Post-Disaster Settings: the Role of Digital Health/Telemental Health

THE PURPOSE REVIEW

This paper will review the literature on global disasters and the mental health impact of disasters, and discuss the use of digital health/telemental health in providing care in post-disaster settings.

RECENT FINDINGS

Global disasters, natural and manmade, are on the rise. As a consequence, there are increases in the health and mental health impact in the affected populations. We examine the literature on the health and mental health impact of disasters and the role of digital health/telemental health in response to meeting those needs. We examine the use of digital health/telemental health in two case examples, one of a natural disaster and one of a man-made disaster. Finally, we examine a blended telemental health model for collaboration between mental health and primary care providers in post-disaster settings. Digital health/telemental health is positioned on the cusp of the technology explosion, thus bringing much needed medical and mental health care to previously under-served populations.

The Evolving Role of Dental Responders on Interprofessional Emergency Response Teams

Disaster and pandemic response events require an interprofessional team of health care responders to organize and work together in high-pressure, time-critical situations. Civilian oral health care professionals have traditionally been limited to forensic identification of human remains. However, after the bombing of the Twin Towers in New York, federal agencies realized that dentists can play significant roles in disaster and immunization response, especially on interprofessional responder teams. Several states have begun to incorporate dentists into the first responder community. This article discusses the roles of dental responders and highlights legislative advancements and advocacy efforts supporting the dental responder.

A Questionnaire Study on the Attitudes and Previous Experience of Croatian Family Physicians toward their Preparedness for Disaster Management

Objective

To explore family physicians' attitudes, previous experience and self-assessed preparedness to respond or to assist in mass casualty incidents in Croatia.

Methods

The cross-sectional survey was carried out during January 2017. Study participants were recruited through a Facebook group that brings together family physicians from Croatia. They were asked to complete the questionnaire, which was distributed via google.docs. Knowledge and attitudes toward disaster preparedness were evaluated by 18 questions. Analysis of variance, Student t test and Kruskal-Wallis test t were used for statistical analysis.

Results

Risk awareness of disasters was high among respondents (M = 4.89, SD=0.450). Only 16.4 of respondents have participated in the management of disaster at the scene. The majority (73.8%) of physicians have not been participating in any educational activity dealing with disaster over the past two years. Family physicians believed they are not well prepared to participate in national (M = 3.02, SD=0.856) and local community emergency response system for disaster (M = 3.16, SD=1.119). Male physicians scored higher preparedness to participate in national emergency response system for disaster (p=0.012), to carry out accepted triage principles used in the disaster situation (p=0.003) and recognize differences in health assessments indicating potential exposure to specific agents (p=0,001) compared to their female colleagues.

Conclusion

Croatian primary healthcare system attracts many young physicians, who can be an important part of disaster and emergency management. However, the lack of experience despite a high motivation indicates a need for inclusion of disaster medicine training during undergraduate studies and annual educational activities.

Health among disaster survivors and health professionals after the Haiyan Typhoon: a self-selected Internet-based web survey

BACKGROUND

Natural disasters affected millions of people worldwide every year. Evaluation of disaster health and health response interventions is faced with several methodological challenges. This study aimed (1) to describe survivors' and health professionals' health, 30 months after a natural disaster using a web-based self-selected Internet sample survey designed and (2) to evaluate the health effects of disaster response interventions, in the present study with a focus on disaster radio.

METHODS

A web-based survey was used to conduct a cross-sectional study approximately 30 months after typhoon Haiyan. The GHQ-12, EQ-5D-3L, and EQ-VAS instruments were used in addition to study-specific questions. A self-selected Internet sample was recruited via Facebook.

RESULTS

In total, 443 survivors, from what 73 were health professionals, participated in the study. The Haiyan typhoon caused both physical and mental health problems as well as social consequences for the survivors. Mental health problems were more frequently reported than physical injuries. Health professionals reported worse overall health and a higher frequency of mental health problems compared to other survivors.

CONCLUSIONS

There were short-term and long-term physical, psychological, and social consequences for the survivors as a result of the Haiyan typhoon. Mental health problems were more frequently reported and lasted longer than physical problems. Health professionals deployed during the disaster reported worse health, especially concerning mental health problems. The survey used was found useful to describe health after disasters.

A regional, market oriented governance for disaster management: A new planning approach

This paper proposes a regional competitive governance and management of response and recovery from disasters. It presents problems experienced in major disasters, analyzes the failures, and suggests how a competitive system that relies on private and volunteer regional leaders, personnel, and capital can improve preparation, response and recovery efforts over the existing government system. A Public Choice approach is adopted to explain why government often fails, and how regional governance may be socially more efficient than the existing federal- state-local funded and managed disaster system. The paper suggests that the federal role might change from both funding and supplying aid in disasters to merely funding disaster recovery efforts. When a disaster occurs, available businesses and government resources in the region can be utilized under a competitive system. These resources could replace existing federal and state inventories and emergency personnel. An independent regionally controlled and managed council, which also develops its own financial resources, and local volunteer leaders are key for success. The paper suggests a new planning method that utilizes the statistical Factor Analysis methodology to derive an efficient organizational and functional model to confront disasters.

Monitoring and evaluation of disaster response efforts undertaken by local health departments: a rapid realist review

Background

Local health departments are often at the forefront of a disaster response, attending to the immediate trauma inflicted by the disaster and also the long term health consequences. As the frequency and severity of disasters are projected to rise, monitoring and evaluation (M&E) efforts are critical to help local health departments consolidate past experiences and improve future response efforts. Local health departments often conduct M&E work post disaster, however, many of these efforts fail to improve response procedures.

Methods

We undertook a rapid realist review (RRR) to examine why M&E efforts undertaken by local health departments do not always result in improved disaster response efforts. We aimed to complement existing frameworks by focusing on the most basic and pragmatic steps of a M&E cycle targeted towards continuous system improvements. For these purposes, we developed a theoretical framework that draws on the quality improvement literature to ‘frame’ the steps in the M&E cycle. This framework encompassed a M&E cycle involving three stages (i.e., document and assess, disseminate and implement) that must be sequentially completed to learn from past experiences and improve future disaster response efforts. We used this framework to guide our examination of the literature and to identify any context-mechanism-outcome (CMO) configurations which describe how M&E may be constrained or enabled at each stage of the M&E cycle.

Results

This RRR found a number of explanatory CMO configurations that provide valuable insights into some of the considerations that should be made when using M&E to improve future disaster response efforts. Firstly, to support the accurate documentation and assessment of a disaster response, local health departments should consider how they can: establish a culture of learning within health departments; use embedded training methods; or facilitate external partnerships. Secondly, to enhance the widespread dissemination of lessons learned and facilitate inter-agency learning, evaluation reports should use standardised formats and terminology. Lastly, to increase commitment to improvement processes, local health department leaders should possess positive leadership attributes and encourage shared decision making.

Conclusion

This study is among the first to conduct a synthesis of the CMO configurations which facilitate or hinder M&E efforts aimed at improving future disaster responses. It makes a significant contribution to the disaster literature and provides an evidence base that can be used to provide pragmatic guidance for improving M&E efforts of local health departments.

Trial registration

PROSPERO 2015:CRD42015023526.

Disaster response under One Health in the aftermath of Nepal earthquake, 2015

Until now, an estimate quotes that 1100 healthcare facilities were damaged and over 100,000 livestock lost in the two earthquakes that occurred in April and May of 2015 in Nepal. Threats of infectious diseases, mostly zoonoses, could affect Nepal's economy, trade, and tourism, and reaching the targets of the United Nations Millennium Development Goals. Historically, outbreaks of infectious diseases, including zoonoses, were largely associated with the aftereffects of the earthquakes. It has been documented that zoonoses constitute 61% of all known infectious diseases. Therefore, the purpose of this communication was to examine the infectious disease outbreaks after earthquakes around the world and explore the risk assessment of the zoonoses threats reported in Nepal and highlight adopting One Health. Our summaries on reported zoonoses in Nepal have shown that parasitic zoonoses were predominant, but other infectious disease outbreaks can occur. The fragile public health infrastructure and inadequately trained public health personnel can accelerate the transmission of infections, mostly zoonoses, in the post impact phase of the earthquake in Nepal. Therefore, we believe that with the support of aid agencies, veterinarians and health professionals can team up to resolve the crisis under One Health.