The effect of multiple triage points on the outcomes (time and accuracy) of hospital triage during mass casualty incidents

INTRODUCTION

During mass casualty incidents (MCIs), the accuracy and timing of the triage of patients by the emergency department (ED) triage officers are essential. The primary triage is performed at the event's location by paramedics and intends a quick evaluation of the victims. Secondary triage may be used when the transfer of the victim is delayed. In this study, we aimed to investigate the effectiveness of two-point triage in a simulated environment of an MCI in the hospital setting.

MATERIALS AND METHODS

In this case-control study, we used an online test module to assess single triage points (Group 1, n = 41) and two triage points (Group 2, n = 40). 60 vignettes for Group 1 and 55 vignettes (5 deceased cases removed) for Group 2 were used. The assessment utilized clinical MCI scenarios in a scheduled online meeting by using the Simple Triage and Rapid Treatment (START) system. Triage time and accuracy of the triage, along with the experience, and previous training of the participants, were assessed.

RESULTS

A total of 81 triage officers participated in this study. The participants were divided into two independent groups homogenously according to their profession and experience. Groups were comparable primarily without any statistically significant difference in terms of the profession (p = 0.101), sex (p = 0.923), and MCI experience (p = 0.785). The difference between the two groups was not significant with regard to having received practical or theoretical triage training (p = 0.099). The mean time of a single vignette triage was 19.2 (SD 6.5) seconds and mean percentage of correct triage score was 65.0 (SD 12.6). The participants had a statistically significantly better performance in the single-point triage group regarding the median triage time (p < 0.001) and median percentages of under triage (p = 0.001), but a worse median percentage of over triage (p < 0.001). However, there was no significant difference between the two groups in terms of the percentage of accurate triage. Emergency residents performed better in accuracy and triage time than their non-physician colleagues (p = 0.019).

CONCLUSIONS

Two-point triage does not demonstrate better outcomes in terms of accuracy and timing. Triage officers should be trained frequently with the preferred training methodology to prevent improper triage accuracy and timing. Well-defined medical disaster planning should include frequent training of the triage officers with case scenarios.

Typhoon disaster emergency forecasting method based on big data

Typhoons are natural disasters characterized by their high frequency of occurrence and significant impact, often leading to secondary disasters. In this study, we propose a prediction model for the trend of typhoon disasters. Utilizing neural networks, we calculate the forgetting gate, update gate, and output gate to forecast typhoon intensity, position, and disaster trends. By employing the concept of big data, we collected typhoon data using Python technology and verified the model's performance. Overall, the model exhibited a good fit, particularly for strong tropical storms. However, improvements are needed to enhance the forecasting accuracy for tropical depressions, typhoons, and strong typhoons. The model demonstrated a small average error in predicting the latitude and longitude of the typhoon's center position, and the predicted path closely aligned with the actual trajectory.

Pediatric Medical Countermeasures: Antidotes and Cytokines for Radiological and Nuclear Incidents and Terrorism

The war in Ukraine raises concerns for potential hazards of radiological and nuclear incidents. Children are particularly vulnerable in these incidents and may need pharmaceutical countermeasures, including antidotes and cytokines. Searches found no published study comparing pediatric indications and dosing among standard references detailing pediatric medications for these incidents. This study addresses this gap by collecting, tabulating, and disseminating this information to healthcare professionals caring for children. Expert consensus chose the following references to compare their pediatric indications and dosing of medical countermeasures for radiation exposure and internal contamination with radioactive materials: Advanced Hazmat Life Support (AHLS) for Radiological Incidents and Terrorism, DailyMed, Internal Contamination Clinical Reference, Medical Aspects of Radiation Incidents, and Medical Management of Radiological Casualties, as well as Micromedex, POISINDEX, and Radiation Emergency Medical Management (REMM). This is the first study comparing pediatric indications and dosing for medical countermeasures among commonly used references for radiological and nuclear incidents.

Earthquake in Turkey: The Triangle of Life and Disaster Kits Saves Lives

OBJECTIVE

Precautions taken before an earthquake are of vital importance. When buildings collapse, the weight of the ceiling crushes objects such as furniture, leaving a space or void within the rubble. This area is called the "triangle of life." The larger and stronger the object, the more it will maintain its volume; the more the object maintains its volume, the larger the void will be, and the less likely it is that the person who uses this void will be injured.

METHODS

Durable, solid furniture such as beds and tables that can be tipped over during an earthquake in appropriate areas in the building can form a living triangle. Creating and using the triangle of life is the method of protection in an earthquake that produces the highest probability of survival.

RESULTS

Two earthquakes with magnitudes of 7.8 and 7.5 occurred in Kahramanmaraş, Turkey, on February 6, 2023. This report presents the case of a 43-y-old female victim of these earthquakes who used the triangle of life to survive; she was removed from the rubble 164 h after the earthquake.

CONCLUSIONS

The case provides evidence that predetermining areas in which the triangle of life can be formed and storing supplies necessary for survival can decrease morbidity and mortality in an earthquake.

[Construction of a Temporary Radiological Image Viewing Network for Large-scale Disasters]

The Ministry of Health, Labor and Welfare mandated the creation of the business continuity plan (BCP) for disaster key hospitals on March 31, 2017. Supposing the hospital information system (HIS) failure occurred, the picture archiving and communication system (PACS) also suffers obstacles, we assumed building a new network was necessary for radiological examination images. The purpose of this study was to investigate whether building a new network for radiological examination images is necessary in an emergency. Using wireless fidelity (Wi-Fi), the new network consisting of one image server and two tablet terminals A and B was constructed. The study measured the portable image transfer time for various stages of the network. The results were as follows: Transfer time from the mobile X-ray unit to the image server was 4.12±0.86 s, that from the image server to the tablet device A was 5.14±0.71 s, and that from the image server to the tablet device B was 7.32±1.66 s. Therefore, the new network configuration can provide a reliable means of accessing radiological images during emergency situations when the HIS and PACS may experience obstacles or failures.

Assessing primary healthcare disaster preparedness: a study in Northern Italy

AIM

The aim of this paper is to outline the steps taken to develop an operational checklist to assess primary healthcare (PHC) all-hazards disaster preparedness. It then describes a study testing the applicability of the checklist.

BACKGROUND

A PHC approach is an essential foundation for health emergency and disaster risk management (H-EDRM) because it can prevent and mitigate risks prior to disasters and support an effective response and recovery, thereby contributing to communities' and countries' resilience across the continuum of the disaster cycle. This approach is in line with the H-EDRM framework, published by the World Health Organization (WHO) in 2019, which emphasizes a whole-of-health system approach in disaster management and highlights the importance of integrating PHC into countries' H-EDRM. Nevertheless, literature focusing on how to practically integrate PHC into disaster management, both at the facility and at the policy level, is in its infancy. As of yet, there is no standardized, validated way to assess the specific characteristics that render PHC prepared for disasters nor a method to evaluate its role in H-EDRM.

METHODS

The checklist was developed through an iterative process that leveraged academic literature and expert consultations at different stages of the elaboration process. It was then used to assess primary care facilities in a province in Italy.

FINDINGS

The checklist offers a practical instrument for assessing and enhancing PHC disaster preparedness and for improving planning, coordination, and funding allocation. The study identified three critical areas for improvement in the province's PHC disaster preparedness. First, primary care teams should be more interdisciplinary. Second, primary care services should be more thoroughly integrated into the broader health system. Third, there is a notable lack of awareness of H-EDRM principles among PHC professionals. In the future, the checklist can be elaborated into a weighted tool to be more broadly applicable.

Hospices and Emergency Preparedness Planning: A Scoping Review of the Literature

Objective. Palliative and end-of-life care, as provided by hospices, are important elements of a healthcare response to disasters. A scoping review of the literature was conducted to examine and synthesize what is currently known about emergency preparedness planning by hospices. Methods. A literature search of academic and trade publications was conducted through 6 publication databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines when applicable. Publications were selected and findings were organized into themes. Results. A total of 26 articles were included in the literature review. Six themes of Policies and Procedures; Testing/Training/Education; Integration and Coordination; Mitigation; Risk Assessment/Hazard and Vulnerability Analysis; and Regulations were identified. Conclusions. This review demonstrates that hospices have begun to individualize emergency preparedness features that support their unique role. The review supports all-hazards planning for hospices, and emerging from this review is a developing vision for expanded roles of hospices to help communities in times of disaster. Continued research in this specialized area is needed to improve hospices' emergency preparedness efforts.

Assessment of Disaster Preparedness at the Household Level in a Pediatric Cardiology Clinic Population

Natural and human-provoked disasters pose serious health risks to children, particularly children and youth with special healthcare needs, including many cardiology patients. The American Academy of Pediatrics (AAP) provides preparedness recommendations for families, but little is known about recommendation adherence. Caregivers of children seen in a pediatric cardiology clinic network were recruited to complete an electronic survey. Participants self-reported child medical history and their household's implementation of AAP recommended disaster preparedness items. Families received a link to AAP resources and a child ID card. Data were analyzed using descriptive statistics with Fisher's exact and Wilcoxon rank sum tests. 320 caregivers participated in the study, of whom 124 (38.8%) indicated that their child has a diagnosed cardiac condition, and 150 (46.9%) indicated that their child had special healthcare needs. The average preparedness item completion rate was 70.7% for household preparedness, 40.1% for reunification preparedness, and 26.3% for community preparedness. Households of children with medical needs had similar rates of preparedness compared to overall rates. Of all respondents, 27.8% previously received disaster preparedness resources, 67.7% would like resources on discussing disaster preparedness, and 93.0% intend to talk with their household about disaster preparedness after completing the survey. These results demonstrate a gap between AAP recommendations and household-level disaster preparedness, including patients with cardiac conditions and those with special healthcare needs. Families expressed that they were interested in getting resources for disaster preparedness. Pediatric cardiologists may consider asking about disaster preparedness and providing disaster preparedness resources tailored to the needs of their patients.

Emergency and disaster preparedness among children and youth with disabilities and chronic conditions, their caregivers and service providers: a scoping review

PURPOSE

People with disabilities, especially children and youth, are often not considered in emergency and disaster preparedness planning, which leaves them vulnerable and at a higher risk of the negative effects of natural and human caused disasters. The purpose of this study was to understand the extent of emergency and disaster preparedness and factors influencing preparedness among children and youth with disabilities and chronic conditions, their caregivers and service providers.

METHODS

Our scoping review involved searching six international databases that identified 1146 studies of which 27 met our inclusion criteria.

RESULTS

The studies in this review involved 2613 participants (i.e., children, parents, educators and clinicians) across nine countries over a 20-year period. Our results highlighted the following trends: (1) the extent of emergency preparedness; (2) factors affecting emergency preparedness; and (3) interventions to enhance preparedness.

CONCLUSIONS

Our findings underscore the critical need for more attention to emergency preparedness for children and youth with disabilities, their families and service providers and their inclusion in planning.

Global prediction of extreme floods in ungauged watersheds

Floods are one of the most common natural disasters, with a disproportionate impact in developing countries that often lack dense streamflow gauge networks1. Accurate and timely warnings are critical for mitigating flood risks2, but hydrological simulation models typically must be calibrated to long data records in each watershed. Here we show that artificial intelligence-based forecasting achieves reliability in predicting extreme riverine events in ungauged watersheds at up to a five-day lead time that is similar to or better than the reliability of nowcasts (zero-day lead time) from a current state-of-the-art global modelling system (the Copernicus Emergency Management Service Global Flood Awareness System). In addition, we achieve accuracies over five-year return period events that are similar to or better than current accuracies over one-year return period events. This means that artificial intelligence can provide flood warnings earlier and over larger and more impactful events in ungauged basins. The model developed here was incorporated into an operational early warning system that produces publicly available (free and open) forecasts in real time in over 80 countries. This work highlights a need for increasing the availability of hydrological data to continue to improve global access to reliable flood warnings.

Mass Decontamination of Companion Dogs in Disaster: Planning for Personnel, Water, and Time Requirements

OBJECTIVE

The importance of companion animals in the daily lives of people, and the increasing incidence and severity of natural disasters impacting people and their animals, is very well documented. However, despite the advancement of companion animal response capabilities, decontamination remains an inconsistently implemented component of disaster response. The challenge for local authorities is their need for planning factors and protocols specific to companion animal decontamination which are generally lacking. Data is provided on the average time requirements, water use and containment resources necessary, and the personnel required to decontaminate (decon) a large number of companion dogs.

METHODS

Sixty-three lightly contaminated, medium weight, short to medium coat, highly tractable dogs (Labradors and Hounds) from a State facility colony were used to determine the water requirements, soap effectiveness, and time required to complete decon (washing/bathing). Data were collected over a 6-mo period using 2 personnel that were randomly assigned to wash the dogs. Difference in weight, bathing time, and water use between groups was evaluated using a 2-tailed 2-sample t-test for independent data.

RESULTS

The time and water requirements were significantly different between medium coated dogs and short coated dogs. On average, for a short coated dog, the amount of time to complete decon was 7 min, and the amount of water was 8-10 gal. For medium coated dogs, the time increased to 10-12 min to complete the process and 12-15 gal water.

DISCUSSION

The results of this study provide important insights emergency management planners, animal response team members, and community personnel tasked with implementation of mass decontamination of companion dogs following a natural or man-made disaster.

Analysis of Military-Civilian Patient Handoff at Vista Forge Multi-Agency Nuclear Disaster Exercise 2022

INTRODUCTION

The leadership of Vista Forge 2022 requested evaluation of the handoff process between military assets and civilian emergency medical services (EMS) providers by the Beth Israel Deaconess Fellowship in Disaster Medicine (BIDMF). Vista Forge was a multi-agency military-civilian full-scale disaster exercise coordinated by the U.S. Military. The exercise, held in Atlanta, Georgia, simulated response to a nuclear bomb in an urban setting by military and civilian disaster teams.

MATERIALS AND METHODS

BIDMF had several two-person teams who monitored handoff procedures between military assets after decontamination and civilian emergency medical services providers during the exercise evaluation.

RESULTS

A verbal handoff between military and civilian entities was usually not done. Triage tags placed on mannequins before decontamination remained attached to the bodies and were sent with them to civilian hospitals. Triage tags were generic military forms without specific radiation or chemical exposure information. Not all decontamination groups had the same medical capabilities, and in a disaster it is unclear how these teams would manage medical emergencies.

CONCLUSIONS

Future studies should develop a standardized handoff procedure to be used in mass casualty situations, and trial it in future multi-agency disaster exercises. Radiation specific triage tags should be considered.

Evaluation of a Disaster Preparedness Curriculum and Medical Students' Views on Preparedness Education Requirements for Health Professionals

OBJECTIVE

In general, medical students perceive themselves as inadequately prepared to assist in disasters. This study evaluated the impact of a disaster preparedness curriculum and medical students' views toward required preparedness education for health care professionals.

METHODS

A comprehensive disaster preparedness curriculum was evaluated on its effect on medical students' views on preparedness education requirements, preparedness, and prior disaster training using self-report survey methodology.

RESULTS

Results provide evidence to support curricular effectiveness in significantly increasing initial participant views of health professionals' education requirements, perceived preparedness for integrating professional roles into the emergency response system, and confidence in exposure risk assessment and triage skills. Most participants possessed limited recent prior disaster training and drill experience. Most interestingly, the majority consistently believed throughout the study that disaster preparedness training should be a medical license mandate.

CONCLUSIONS

For those instructing current medical students in disaster preparedness, it is suggested that a curriculum be chosen that can create participant initial anticipation, awareness, and belief in the importance of and need for disaster preparedness training. Further investigation is recommended into the relationship between students' perceived training importance and any future curriculum delivery efforts on behalf of required or mandatory preparedness offerings in continuing professional development.

Emergency and Disaster Preparedness for Individuals Who Use Augmentative and Alternative Communication: A Pilot Study on Supported Planning Using a Toolkit

PURPOSE

When emergencies or disasters arise, individuals who use augmentative and alternative communication (AAC) are particularly vulnerable. It is critical that individuals who use AAC are supported to make decisions that impact their own lives and are able to communicate during such a crisis. Preparedness efforts that include a plan around communication needs and supports are necessary for ensuring that individuals who use AAC are able to understand options that ensure personal safety and express their needs during a time of crisis.

METHOD

Qualitative methods were used to identify and describe the experiences of two young adults who use AAC and their caregivers when engaging in person-centered planning intervention sessions to complete the activities of the United States Society for Augmentative and Alternative Communication (USSAAC) emergency/disaster preparedness toolkit. Pre-intervention interviews and subjective, objective, assessment, and plan (SOAP) notes taken after each intervention session were done to describe their preparedness and experiences completing the toolkit. Themes were identified to describe participant experiences and change in their perceived preparedness.

RESULTS

Five themes and 18 subthemes emerged from the pre-intervention interviews and the SOAP notes across 14 intervention sessions that captured each participant and their caregiver's awareness of needs, barriers in emergency situations, challenges in completing the toolkit, and actions during person-centered planning with the toolkit (e.g., personalizing communication boards, making a go bag, and scheduling visits with local emergency agencies).

CONCLUSIONS

This study highlights the need for preparedness activities that are person-centered and account for the communication support needs of individuals who use AAC if faced with an emergency/disaster. Outcomes suggest that these methods were feasible and supported positive change in perceived preparedness in the young adults who used AAC and their caregivers.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24415567.

Community resilience across Australia towards natural hazards: an application of the Conjoint Community Resiliency Assessment Measurement

Natural hazards can turn into disasters when not managed well. An important part of disaster risk reduction is to understand how well communities are prepared for natural hazards and how well they can cope with and recover from shocks in the long term. This research assesses self-reported community resilience and asks what makes a community resilient, using Australia as a case study. It reports on an Australian-wide online survey which included questions related to the Conjoint Community Resiliency Assessment Measurement, a subjective indicator, as well as questions about risk perception, well-being, and self-efficacy. Community resilience was found to be moderately high but scores for community leadership and preparedness were low. Perceived community resilience was positively correlated with age and those with high scores for self-efficacy and well-being. There was, as expected, an inverse relationship between reliance on external support during natural hazards and self-efficacy. The results complement previous studies which used different measures of community resilience.

Incident commander decision making: Quantitative evaluation of instantaneous and considered decisions

The Incident Commander (IC) decision-making process has previously been modeled primarily by qualitative evaluation methods, which has made it difficult to generalize an objective model. In this study, we took a quantitative approach to elucidate a decision-making model based on the "dual-process" model that consists of instantaneous decisions ("System 1") and considered decisions ("System 2") to gain new insights regarding the IC decision-making process. High-fidelity simulation data from eight mass-casualty incidents (MCIs) were analyzed in two categories. The first category represents cues of new information and the IC's actions, divided into three main subcategories: actions following the MCI protocol, responses following cues, and actions without a cue. The second category divides the simulation into three MCI management phases: (1) evaluation and triage, (2) treatment and preparedness for evacuation, and (3) evacuation. Actions that followed the MCI protocol were significantly higher in the first phase compared to the other two phases (p<0.01 for both phases). Responses following cues were significantly higher in the second phase compared to the first (p<0.01). Actions without a cue were significantly higher in both the second and third phases compared to the first (p<0.01 for both phases). The results reveal that the IC followed MCI protocol guidance in the simulation initiation and immediately responded to cues, which fits "System 1". As the simulation evolved, the IC made more planned tasks and initiated actions without leading cues, which fits "System 2". The study found that ICs can change their decision-making mode, and this understanding can serve to improve their decision-making process and increase casualty survival rates.

[Inpatient surgical treatment in mass casualty situations and disasters-Current treatment capacities depending on alarm status of the hospital and treatment concept]

BACKGROUND

The functionality and treatment capacity of hospitals are decisive components to safeguard the in-hospital treatment of patients in crises and catastrophes. This is shown by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic and the war in Ukraine. The aim of this study is the elicitation of treatment capacities of hospitals in the trauma network of the German Society for Trauma Surgery (DGU) assuming a damage situation with a multitude of trauma patients needing treatment.

MATERIAL AND METHOD

The 622 hospitals in the trauma network were surveyed to elicit the current treatment capacities depending on the principles and standards of treatment. For this purpose, a questionnaire for voluntary participation in the survey was placed online via the Academy of Trauma Surgery (AUC) of the DGU and an electronic platform (SurveyMonkey). The data presented in this article represent an extract of the total data focussed on the issues involved in the study.

RESULTS

A total of 252 of the 622 hospitals certified in December 2022 (40%) participated in the survey and 250 datasets could be utilized. Local, regional and supraregional trauma centers were equally represented. Using a tactical abbreviated surgical control (TASC) focussed on survival, the treatment capacities in the individual triage categories could be increased with respect to the scenarios in question. It was also clear that the availability of teams skilled in the surgical treatment of body cavity injuries still represents a challenge.

CONCLUSION

The results of the survey demonstrate the extent to which treatment capacities for the care of injured and wounded patients are currently available in the hospitals of the DGU trauma network and to what extent they can be increased. In this way, due the dynamics a mass casualty incident can initially lead locally and temporarily to a decompensated crisis management. The aim of all efforts and preparations must therefore be to durably strengthen hospitals so that this can be avoided as reliably as possible and to include these considerations in the hospital structural reform.

Aligning disaster recovery to company technical direction and objectives

One of the many concerns of disaster recovery specialists is how to create disaster recovery scenarios, strategies and related solutions that meet the vision of management while building solutions for the critical business process within budget, with refined technical resources and operational and maintenance processes and procedures similar to those utilised in production. Rather than consider disaster recovery as a separate environment from production, this paper suggests that there are areas where the disaster recovery solution can map more closely to production solutions to better manifest the critical business process, avoiding the decreased sales forecasts and reputational impacts resulting from an outage. There is no magic here - just ideas for designing a solution and enhancements to the disaster recovery programme that may help to meet business expectations. A disaster recovery site based on similar production technical solutions and overall corporate IT vision can provide such benefits as: faster recovery time objective; faster availability of the data while maintaining data integrity; fewer manual procedures during switch/failover; ability to utilise similar resources to work both environments resulting in a smaller training programme; similar operational and maintenance processes and procedures; ability to switchover components rather than declaring disaster recovery; and an environment that supports production by running critical business process while production suffers an outage or requires maintenance. This paper provides readers with ideas to take back to their disaster recovery solution and how it manifests the critical business process during an outage.

"One community at a time": promoting community resilience in the face of natural hazards and public health challenges

BACKGROUND

Resilience is vital for facing natural disasters and public health challenges. Despite the significance of resilience-building activities, there is a scarcity of locally-tailored planning and response strategies, leaving communities incapable of addressing the unique challenges posed by natural disasters and public health crises. This study aims to explore how the "One Community at a Time" approach enhances community resilience in facing natural hazards and public health challenges.

METHODS

A systematic review was conducted over journal articles published from January 2001 to April 2023 through PRISMA approach. Multiple databases such as Web of Science and Scopus were thoroughly searched. We used independent screening by two researchers and painstaking data extraction using standardized forms. This approach was adopted to assure the reliability, validity, and precision of our study selection and analysis. The included studies' quality was evaluated by the Mixed Methods Appraisal Tool.

RESULTS

In the evaluation, 35 studies were deemed eligible for inclusion and underwent in-depth examination. Several major components of "One Community at a Time" have been identified, including social capital and networks, local knowledge and learning, effective governance and leadership, preparedness and response capacity, and adaptive infrastructure and resources. This framework highlights the significance of individualized approaches to resilience-building initiatives, recognizing that each community has specific strengths, needs, and challenges.

CONCLUSION

Relevant stakeholders can adapt suitable resilient strategies to help prepare and recover from natural hazards and public health challenges. By adopting a localized strategy, stakeholders can collaborate to develop a culture of readiness and resilience, ultimately leading to more sustainable and resilient communities. This framework advises community-based groups, local government, and other stakeholders on prioritizing partnerships, preparedness planning, community participation, and leadership as essential components of creating and maintaining resilience. "One Community at a Time" framework offers practical guidance for community-based organizations, local government, and other stakeholders to prioritize partnerships, preparedness planning, community participation, and leadership as essential components of creating and sustaining resilience.

A disaster medicine course for Canadian medical students: first implementation of a large-scale mass-casualty simulation

Mass-casualty incidents have a significant global impact. Despite calls for improved disaster-preparedness training, most medical curriculums do not include formal disaster-medicine education. In 2021, the Medical Council of Canada introduced new disaster-medicine learning objectives. This article presents a mass-casualty-incident course for 3rd-year Canadian medical students. The course includes lectures, and a large-scale simulation of an explosion scene, field triage zone, and simulated emergency department (ED). The simulation incorporated "Dark-team-member" facilitators and 17 live actor and 8 mannequin patients with moulage. Pre-/post-event evaluation data was collected. One-hundred and twenty medical students participated in the course. Confidence in managing a real mass-casualty incident, on a scale from 1 to 10 (no-confidence to completely confident) significantly improved based on a Mann-Whitney U test, p < 0.05. Few formal medical student mass-casualty-incident courses exist. Combining "Dark-team-members" with live actors, imbedding clinician facilitators with medical students, and having a simulation with a continuous disaster scene to the ED are unique to this course. The methodology is presented for future replication.

Developing the Disaster Medical Responder's Course in Singapore

Problem

Emergency medical teams (EMTs) deployed to mass casualty incidents (MCIs) are required to work outside their usual settings and according to different principles, which may affect their performance and the survival of casualties. Prior to 2013, training offered to domestic EMTs was limited to ad hoc and infrequent simulation exercises.

Context

Domestic EMTs are activated from public tertiary hospitals to provide pre-hospital medical support to the Singapore Civil Defence Force and establish a first-aid post (FAP) for triaging, stabilizing and treating casualties. These casualties are then evacuated to public hospitals for further management.

Action

Recognizing the need for a more systematic approach to the training of domestic EMTs, the Disaster Medical Responder's Course (the Course) was developed as a multiinstitutional collaboration to equip EMT members attending a MCI with the necessary skills to perform effectively at the FAP.

Outcome

The Course was first run in 2013 and is usually offered six to eight times a year. Since June 2019, a total of 414 health-care staff and allied health professionals have participated. There have been numerous revisions of the course content and delivery to reflect the latest concepts in operations and global best practice, as well as developments in educational methodologies.

Discussion

Preparedness is crucial to optimize the survival and outcomes of casualties. The Course provides standardized training of domestic EMTs and plays a pivotal role in ensuring operational readiness for MCIs in Singapore.

The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards

BACKGROUND

Mass casualty incidents (MCI) pose significant challenges to existing resources, entailing multiagency collaboration. Triage is a critical component in the management of MCIs, but the lack of a universally accepted triage system can hinder collaboration and lead to preventable loss of life. This multinational study uses validated patient cards (cases) based on real MCIs to evaluate the feasibility and effectiveness of a novel Translational Triage Tool (TTT) in primary triage assessment of mass casualty victims.

METHODS

Using established triage systems versus TTT, 163 participants (1575 times) triaged five patient cases. The outcomes were statistically compared.

RESULTS

TTT demonstrated similar sensitivity to the Sieve primary triage method and higher sensitivity than the START primary triage system. However, the TTT algorithm had a lower specificity compared to Sieve and higher over-triage rates. Nevertheless, the TTT algorithm demonstrated several advantages due to its straightforward design, such as rapid assessment, without the need for additional instrumental interventions, enabling the engagement of non-medical personnel.

CONCLUSIONS

The TTT algorithm is a promising and feasible primary triage tool for MCIs. The high number of over-triages potentially impacts resource allocation, but the absence of under-triages eliminates preventable deaths and enables the use of other personal resources. Further research involving larger participant samples, time efficiency assessments, and real-world scenarios is needed to fully assess the TTT algorithm's practicality and effectiveness in diverse multiagency and multinational contexts.

Factors Associated With Delayed Pre-Hospital Times During Trauma-Related Mass Casualty Incidents: A Systematic Review

OBJECTIVE

Critically injured patients have experienced delays in being transported to hospitals during Mass Casualty Incidents (MCIs). Extended pre-hospital times (PHTs) are associated with increased mortality. It is not clear which factors affect overall PHT during an MCI. This systematic review aimed to investigate PHTs in trauma-related MCIs and identify factors associated with delays for triaged patients at incident scenes.

METHODS

This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Web of Science, CINAHL, MEDLINE, and EMBASE were searched between January and February 2022 for evidence. Research studies of any methodology, and grey literature in English, were eligible for inclusion. Studies were narratively synthesized according to Cochrane guidance.

RESULTS

Of the 2025 publications identified from the initial search, 12 papers met the inclusion criteria. 6 observational cohort studies and 6 case reports described a diverse range of MCIs. PHTs were reported variably across incidents, from a median of 35 minutes to 8 hours, 8 minutes. Factors associated with prolonged PHT included: challenging incident locations, concerns about scene safety, and adverse decision-making in MCI triage responses. Casualty numbers did not consistently influence PHTs. Study quality was rated moderate to high.

CONCLUSION

PHT delays of more than 2 hours were common. Future MCI planning should consider responses within challenging environments and enhanced timely triage decision-making.

Historical narratives about the COVID-19 pandemic are motivationally biased

How people recall the SARS-CoV-2 pandemic is likely to prove crucial in future societal debates on pandemic preparedness and appropriate political action. Beyond simple forgetting, previous research suggests that recall may be distorted by strong motivations and anchoring perceptions on the current situation1-6. Here, using 4 studies across 11 countries (total n = 10,776), we show that recall of perceived risk, trust in institutions and protective behaviours depended strongly on current evaluations. Although both vaccinated and unvaccinated individuals were affected by this bias, people who identified strongly with their vaccination status-whether vaccinated or unvaccinated-tended to exhibit greater and, notably, opposite distortions of recall. Biased recall was not reduced by providing information about common recall errors or small monetary incentives for accurate recall, but was partially reduced by high incentives. Thus, it seems that motivation and identity influence the direction in which the recall of the past is distorted. Biased recall was further related to the evaluation of past political action and future behavioural intent, including adhering to regulations during a future pandemic or punishing politicians and scientists. Together, the findings indicate that historical narratives about the COVID-19 pandemic are motivationally biased, sustain societal polarization and affect preparation for future pandemics. Consequently, future measures must look beyond immediate public-health implications to the longer-term consequences for societal cohesion and trust.

Nurse Perceptions of Knowledge and Preparedness for Disasters

OBJECTIVE

The study aimed to determine the level of knowledge and perceptions of preparedness for disasters among nurses working in a tertiary university hospital.

METHOD

The population of this cross-sectional study consisted of nurses working in a university hospital in the Eastern Black Sea Region of Turkey (n = 340). The sample included 183 nurses who were determined using the OpenEpi program and the universal sampling method. The data were collected using the Sociodemographic Information Form and the Disaster Preparedness Perception Scale in Nurses (DPPSN) and analyzed using SPSS 22 software.

RESULTS

The mean age of the participants was 34.31 + 8.52 years; 83.1% were female, 66.1% had at least a bachelor's degree and worked in a surgical ward, 49.7% had been working for at least 11 years, and 58.5% had received training on disasters. Those who received disaster-related training received it mostly face to face (70.1%) from their institutions (91.6%) and in the form of 2-4 hours of training (75.7%); 52.5% had previously participated in a disaster-related drill, and 83.1% took on the role of caregiver during a disaster. The DPPSN mean score of the nurses involved in the study was found to be 3.53 ± 0.58 out of 5 points for the total scale.

CONCLUSION

The results of the study showed that nurses considered themselves partially adequate for disaster preparedness, in general.

No Kākou, Na Kākou - For Us, By Us: Native Hawaiians and Pacific Islanders Informing Race Data Collection Standards for Hawai'i

This article describes recommendations for standardized race data collection developed by the Hawai'i Native Hawaiian and Pacific Islander COVID-19 Response, Recovery, and Resilience Team (NHPI 3R Team). These recommendations attempt to address the expressed desires of Native Hawaiians and the diverse Pacific Islander communities in Hawai'i who seek greater visibility in data and research. The Native Hawaiian and Pacific Islander (NHPI) racial category is 1 of the 5 racial categories listed in the 1997 Statistical Policy Directive #15 issued by the Office of Management and Budget (OMB). The OMB directive sets the minimum standard for collection of race data in federal surveys, administrative forms, records, and other data collection. The NHPI 3R Team's recommendation provides a standard for detailed data collection that could improve smaller communities' ability to identify, advocate for, and address their own needs. The article also describes lessons learned through the collaborative and iterative process that was led by members and leaders of NHPI communities impacted by data driven decisions and policies. The NHPI 3R Team focused on expanding and standardizing race data collection as part of their COVID-19 response efforts, but implementation of the recommendations could produce benefits well beyond the pandemic.

Investigating the impact of a community disaster awareness training on subjective disaster preparedness: the case of Myanmar's Ayeyarwaddy region

This paper investigates the impact of a community disaster awareness training on subjective disaster preparedness, focusing on the case of a Republic of Korean aid-supported disaster risk reduction project in the Ayeyarwaddy region of Myanmar. A subsequent survey by the authors of a total of 182 households, an equal number of project participating and control households, produced encouraging results regarding the endeavour. Although both ordinal logistic regression and ordinary least squares models support overall robust effectiveness of participating in the project, the results also reveal different effects of specific activities. Disaster risk reduction (DRR) awareness meetings and trainings, and personal visits to share knowledge and/or to distribute informative flyers, are important. In contrast, the significance of drills or community activities, in mass, is lost in a combined model. Consequently, 'personalising risk' should be prioritised in any DRR undertaking, as well as, and in particular, development cooperation aimed at increasing confidence in disaster preparedness.

World Organisation for Animal Health Members' Capacity to Deal With Animal Welfare Emergencies During Natural Disasters in Europe

OBJECTIVE

Little is known about individual European countries or regional capacity to respond to animal welfare emergencies during natural disasters; therefore, it is important to establish baseline information (eg, types of disasters, training) to enable more focused and data-driven actionable support for future disasters.

METHODS

A 55-question survey was distributed by an email link to the 53 World Organisation for Animal Health (WOAH) European Region Members plus 1 observer country.

RESULTS

Forty-nine countries (91%, n = 54) responded to the survey. Fifty-one percent (25/49) indicated they incorporated animal welfare into their national disaster regulatory framework, whereas 59% (29/49) indicated animal welfare was incorporated in the Veterinary Service National Disaster Management and Risk Reduction Plan. Thirty-nine percent (19/49) indicated they had "no" or "limited" legal authority to manage animal emergencies in natural disasters. Floods, forest fires, and snowstorm/extreme cold were the 3 most commonly reported disasters over the last 10 years with 79% (27/34) reporting Veterinary Services was involved in managing these disasters.

CONCLUSION

The survey results indicated a wide range in the capacity of WOAH European Member Countries to respond to animal welfare in natural disasters, highlighting the gaps and potential areas of improvement in this arena.

Prioritized reconstruction of healthcare facilities after earthquakes based on recovery of emergency services

Earthquakes can disrupt the healthcare system heavily, leading to long wait times and many untreated patients for years after the event. Emergency services, in particular, must return to preearthquake functionality as soon as possible such that patients, especially critically injured ones, can be treated promptly. However, reconstruction and restoration of emergency services can take years. Due to limited reconstruction resources, decision-makers cannot reconstruct all hospitals simultaneously. They are typically forced to prioritize the reconstruction order, and this process is often poorly planned. This article models emergency services as an M/M/s queuing system that accounts for prioritized treatment of critical patients and formulates a greedy algorithm to plan for an effective healthcare system reconstruction. The algorithm finds the reconstruction ordering of hospital buildings such that emergency patients have the shortest time to receiving medical care possible. We show our greedy algorithm's good performance for small problem instances, with average deviations from the optimal solution below 16%. Further, we apply our methodology to a case study of Lima, Peru, under a hypothetical M8.0 earthquake. The application demonstrates that compared to typically implemented policies, a policy guided by our formulation results in shorter time to treatment and reduces the number of untreated patients over the course of the reconstruction period by more than a factor of 3 in a worst-case scenario with 70% hospital capacity disruption. Finally, we demonstrate that our formulation can be integrated into risk analysis through Monte Carlo simulations to inform decision-makers of reconstruction plans after future earthquakes.

Longitudinal multiplexity and structural constraints of online emergency collaborative networks: A tale of two Chinese societies

Drawing upon the concept of longitudinal multiplexity and the Institutional Collection Action (ICA) framework, this article conducts a longitudinal observation of online emergency collaborative networks (ECNs) built and sustained among organizational actors within Shenzhen and Hong Kong in response to Typhoon Mangkhut. In addition to investigating the multiplex relationships among three types of online ECNs (i.e., preparedness networks, response networks, recovery networks), this article takes a comparative approach to examining how the structural constraints imposed by distinct emergency management systems (EMSs) influence the network formation and evolution as the disaster evolves over time. Findings obtained from a series of inferential network analyses reveal that preexisting online collaborative ties formed at the disaster preparedness stage are important for increasing organizations' tendency to build and sustain online collaborations during disaster response and recovery. Moreover, the decentralized EMS in Hong Kong exhibits more effectiveness in facilitating online network changes during both transitional periods. These findings demonstrate a pressing need for emergency researchers and frontline communication managers to understand the dynamic relationships among online ECNs across different disaster phases and further explore potential opportunities to facilitate online emergency collaboration on a broader scale.

Building Public Health Emergency Preparedness, Response, and Recovery Capabilities Through Disaster Citizen Science: Perspectives From Local Health Department, Academic, and Community Representatives

CONTEXT

Disaster citizen is the use of scientific methods by the public to address preparedness, response, or recovery needs. Disaster citizen science applications with public health relevance are growing in academic and community sectors, but integration with public health emergency preparedness, response, and recovery (PHEPRR) agencies is limited.

OBJECTIVE

We examined how local health departments (LHDs) and community-based organizations have used citizen science to build public health preparedness and response (PHEP) capabilities. The purpose of this study is to help LHDs make use of citizen science to support PHEPRR.

DESIGN

We conducted semistructured telephone interviews (n = 55) with LHD, academic, and community representatives engaged or interested in citizen science. We used inductive and deductive methods to code and analyze interview transcripts.

SETTING

US and international community-based organizations and US LHDs.

PARTICIPANTS

Participants included 18 LHD representatives reflecting diversity in geographic regions and population sizes served and 31 disaster citizen science project leaders and 6 citizen science thought leaders.

MAIN OUTCOMES

We identified challenges LHDs and academic and community partners face in using citizen science for PHEPRR as well as strategies to facilitate implementation.

RESULTS

Academic and community-led disaster citizen science activities aligned with many PHEP capabilities including community preparedness, community recovery, public health surveillance and epidemiological investigation, and volunteer management. All participant groups discussed challenges related to resources, volunteer management, collaborations, research quality, and institutional acceptance of citizen science. The LHD representatives noted unique barriers due to legal and regulatory constraints and their role in using citizen science data to inform public health decisions. Strategies to increase institutional acceptance included enhancing policy support for citizen science, increasing volunteer management support, developing best practices for research quality, strengthening collaborations, and adopting lessons learned from relevant PHEPRR activities.

CONCLUSIONS

There are challenges to overcome in building PHEPRR capacity for disaster citizen science but also opportunities for LHDs to leverage the growing body of work, knowledge, and resources in academic and community sectors.

Looking Ahead in the Rearview Mirror: During Action Review and Tabletop (DART) to Strengthen Health Emergency Readiness and Resiliency

During health emergencies, such as the COVID-19 pandemic, systematic evaluation of capabilities, and multisector coordination are challenging while operating in triage mode. During Action Review and Tabletop (DART) identifies recommendations for strengthening readiness and resiliency by creating a single methodology integrating retrospective analysis of the response to date with a prospective analysis of future scenarios. DART utilizes a role-based questionnaire and participant-led discussion for retrospective response review and identification of future scenarios of concern. Tabletop exercises exploring those future scenarios are conducted in a multi-role format to assess readiness and resiliency. Participants evaluate findings to determine recommended actions to improve response capabilities. 3 COVID-19 focused DARTs demonstrated the ability of this participant-led approach to systematically assess, not only readiness for today, but also resiliency to future complications. While demonstrating its usefulness during COVID-19, DART's flexible and modular design promises to be an effective for any ongoing health emergency.

Effectiveness of and Adherence to Triage Algorithms During Prehospital Response to Mass Casualty Incidents

Mass casualty incidents (MCIs) can rapidly exhaust available resources and demand the prioritization of medical response efforts and materials. Principles of triage (i.e., sorting) from the 18th century have evolved into a number of modern-day triage algorithms designed to systematically train responders managing these chaotic events. We reviewed reports and studies of MCIs to determine the use and efficacy of triage algorithms. Despite efforts to standardize MCI responses and improve the triage process, studies and recent experience demonstrate that these methods have limited accuracy and are infrequently used.

Quantitative risk assessment of typhoon storm surge for multi-risk sources

Typhoon storm surge (TSS) is a complex marine disaster affected by multi-risk sources. Quantitative risk assessment is an important prerequisite for identifying risk areas and designing risk reduction strategies. This paper aims to propose a rapid, accurate, and comprehensive quantitative risk assessment method for TSS under multi-risk sources, including disaster occurrence probability and severity. First, identify the primary risk sources according to the disaster-causing mechanism of TSS. Then, based on the official public data from 1989 to 2020, the dependence structure among multi-risk sources is constructed using Copulas to calculate the probability of each superposition scenario. Meanwhile, build visual scenario databases employing Geographical Information System (GIS) techniques. Subsequently, the extent and depth of inundation are translated into economic risk and population risk using GIS and depth-damage functions. Finally, taking the "Mangkhut" as a case study, the method's feasibility and accuracy are verified. The results show that the primary risk sources of TSS are storm tide, astronomical tide and coastal waves. The Gumbel Copula is optimal, with OLS (ordinary least squares) and D of 0.0186 and 0.1831, respectively. The probability assessment under different superposition scenarios indicates that the greatest threat of TSS in Guangzhou comes from the storm tide and the astronomical tide. As for the "Mangkhut" case study in Jiangmen City, the assesses occurrence probability is 0.0355%, the accuracy of economic risk assessment (except mariculture) is 95.28%, and the accuracy of population risk assessment is 98.60%. Residences and the disaster-bearing bodies in 0-3 m inundation depth are most severely affected by TSS disasters. Measures such as locating residential and important buildings away from the shoreline (at least 10 km) and ground (above 3 m), formulating disaster emergency plans, and developing the forecast and prevention of storm tides and astronomical tides will help ensure the safety of residents' life and property. This paper provides an efficient and accurate method, which is of great significance for disaster control, sustainable development, and decision-making.

The Need for a Preparedness Training Model on Disaster Risk Reduction Based on Culturally Sensitive Public Health Nursing (PHN)

The Indonesian Disaster Risk Index (IRBI) in 2018 found that 52.33% of districts or cities in Indonesia were at high risk of natural disasters and the others were at moderate risk. The World Risk Index places Indonesia at number 33 in the very high-risk category. The policy direction of the Implementation of Disaster Management in Indonesia in 2020-2024 is to increase disaster resilience toward sustainable prosperity for sustainable development.

PURPOSE

This study aims to identify the various needs for a culturally sensitive PHN-based disaster risk-reduction preparedness training model.

METHODS

This study used a descriptive qualitative research design. Data collection was done through in-depth interviews, Focus Group Discussions (FGDs), and expert panel stages in the Indonesian language. Samples involved in the research included 4 experts and 11 informants.

RESULTS

There were 10 themes generated from the results. The analysis results revealed that the level of knowledge, attitudes, and skills of the community is still low. Almost all of the people of Mekar Mukti Village stated that they had never received community-based disaster management training.

CONCLUSIONS

The study findings highlighted the importance of the Disaster Risk-Reduction Preparedness Model Based on Culturally Sensitive Public Health Nursing for the community.

An Interdisciplinary Approach to Quantify the Human Disaster Risk Perception and Its Influence on the Population at Risk: A Case Study of Longchi Town, China

Understanding disaster risk perception is vital for community-based disaster risk reduction (DRR). This study was set to investigate the correlations between disaster risk perception and the population at risk. To address this research question, the current study conducted an interdisciplinary approach: a household survey for measuring variables and constructed an Agent-based model for simulating the population at risk. Therefore, two correlations were defined, (1) between risk perception and willingness to evacuate, and (2) between willingness to evacuate and the population at risk. The willingness to evacuate was adopted as a mediator to determine the relationship between risk perception and the population at risk. The results show that the residents generally have a higher risk perception and willingness to evacuate because the study area frequently suffered from debris flow and flash floods. A positive correlation was found between risk perception and willingness to evacuate, and a negative correlation to the population at risk. However, a marginal effect was observed when raising public risk perception to reduce the number of the population at risk. This study provides an interdisciplinary approach to measuring disaster risk perception at the community level and helps policymakers select the most effective ways to reduce the population at risk.

Effectiveness of the virtual reality chemical disaster training program in emergency nurses: A quasi experimental study

BACKGROUND

In Taiwan, 50 % of the chemical disasters in the last decade were industrial accidents. The leakage of industrial toxic chemical substances may cause significant environmental pollution and harms. Taiwan's chemical disaster education and training mainly rely on simulation, which is labor-intensive, time-consuming, and costly. Tabletop drills are often used to as a substitute for simulations. However, tabletop drills lack a realistic presence. The 360° virtual reality (VR) transforms knowledge of disaster preparedness into audio-visual and other sensory experiences and allows participants to be physically immersed in an environment.

PURPOSE

This study examined effectiveness of a "360° VR chemical disaster training program" on disaster preparedness and self-efficacy in ER nurses.

METHOD

This study used convenience sampling and quasi-experimental design with two-group repeated measures. Seventy-seven ER nurses were recruited with the experimental group (n = 32) receiving chemical disaster training through 360° VR and the control group (n = 35) receiving training through tabletop drills. Data were collected before, one week after and three weeks after the intervention.

RESULT

Participants in the experimental group were significantly younger and less experienced in disaster management than those in the control group. There were no between-group differences in the participants' self-assessment of chemical disaster preparedness and self-efficacy before the intervention. The intervention group showed significantly higher self-assessment chemical disaster preparedness scores than the comparison group (p < .05) one week after the intervention. However, no significant differences were found three weeks after the intervention.

CONCLUSION

This study found that both 360° VR and tabletop drills improved preparedness and self-efficacy in chemical disasters among ER nurses. VR could be used for disaster preparedness training for nurses without prior disaster response experiences/ drills, whereas tabletop drills were more suitable for nurses with prior experiences. Both methods may effectively promote nurses' learning effectiveness and self-efficacy in chemical disaster preparedness.

Preparing for Pandemics and Other Health Threats: Societal Approaches to Protect and Improve Health

This Viewpoint discusses 3 areas in need of progress regarding societal approaches to pandemics and other health threats: a renaissance in public health; robustness of primary health care; and resilience of individuals and communities, with higher levels of trust in government and society.

Public Health Decision Making in the Case of the Use of a Nuclear Weapon

The current geopolitical situation and the war on Ukraine's territory generate questions about the possible use of a nuclear weapon and create the need to refresh emergency protective plans for the population. Ensuring the protection of public health is a national responsibility, but the problem is of international size and global scale. Radiological or nuclear disasters need suitable decision making at the right time, which determine large effective radiation protection activities to ensure public health is protected, reduce fatalities, radiation disease, and other effects. In this study, a simulation of a single nuclear weapon detonation with an explosion yield of 0.3 and 1 Mt was applied for a hypothetical location, to indicate the required decision making and the need to trigger protocols for the protection of the population. The simulated explosion was located in a city center, in a European country, for the estimation of the size of the effects of the explosion and its consequences for public health. Based on the simulation results and knowledge obtained from historical nuclear events, practical suggestions, discussion, a review of the recommendations was conducted, exacerbated by the time constraints of a public health emergency. Making science-based decisions should encompass clear procedures with specific activities triggered immediately based on confirmed information, acquired from active or/and passive warning systems and radiometric specific analysis provided by authorized laboratories. This study has the potential to support the preparedness of decision makers in the event of a disaster or crisis-related emergency for population health management and summarizes the strengths and weaknesses of the current ability to respond.

Factors Influencing Public Participation in Community Disaster Mitigation Activities: A Comparison of Model and Nonmodel Disaster Mitigation Communities

Public participation in community-organized disaster mitigation activities is important for improving disaster mitigation capacity. With data from 260 questionnaires, this study compared the current status of public participation in model disaster mitigation communities and nonmodel communities in a geological-disaster-prone area. Three community-organized disaster mitigation education activities were compared cross-sectionally. A binary logistic regression was used to analyze the effects of attitude, perceived behavioral control, disaster experience, and other key factors on the public's choice to participate in community disaster mitigation activities. The analysis results indicated that model communities had higher public participation in two efforts, evacuation drills and self-help skills training, and lower participation in activities that invited them to express their feedback than nonmodel communities. The influence of attitudinal factors on the decision to participate in disaster mitigation activities had a high similarity across community types. The public participation in model disaster mitigation communities is influenced by factors such as subjective norms and participation cognition; the behavior of people in nonmodel communities is influenced by factors such as previous experience with disasters, perceived behavioral control, risk perception, and participation cognition and has a greater potential for disaster mitigation community construction. This study provides practical evidence and theoretical support for strengthening the sustainable development of disaster mitigation community building.

Valuing Human Impact of Natural Disasters: A Review of Methods

This paper provides a comprehensive set of methodologies that have been used in the literature to give a monetary value to the human impact in a natural disaster setting. Four databases were searched for relevant published and gray literature documents with a set of inclusion and exclusion criteria. Twenty-seven studies that quantified the value of a statistical life in a disaster setting or discussed methodologies of estimating value of life were included. Analysis highlighted the complexity and variability of methods and estimations of values of statistical life. No single method to estimate the value of a statistical life is universally agreed upon, although stated preference methods seem to be the preferred approach. The value of one life varies significantly ranging from USD 143,000 to 15 million. While an overwhelming majority of studies concern high-income countries, most disaster casualties are observed in low- and middle-income countries. Data on the human impact of disasters are usually available in disasters databases. However, lost lives are not traditionally translated into monetary terms. Therefore, the full financial cost of disasters has rarely been evaluated. More research is needed to utilize the value of life estimates in order to guide policymakers in preparedness and mitigation policies.

Emergency Relief Chain for Natural Disaster Response Based on Government-Enterprise Coordination

Public health and effective risk response cannot be promoted without a coordinated emergency process during a natural disaster. One primary problem with the emergency relief chain is the homogeneous layout of rescue organizations and reserves. There is a need for government-enterprise coordination to enhance the systemic resilience and demand orientation. Therefore, a bi-level multi-phase emergency plan model involving procurement, prepositioning and allocation is proposed. The tradeoff of efficiency, economy and fairness is offered through the multi-objective cellular genetic algorithm (MOCGA). The flood emergency in Hunan Province, China is used as a case study. The impact of multi-objective and coordination mechanisms on the relief chain is discussed. The results show that there is a significant boundary condition for the coordinated location strategy of emergency facilities and that further government coordination over the transition phase can generate optimal relief benefits. Demand orientation is addressed by the proposed model and MOCGA, with the realization of the process coordination in multiple reserves, optimal layout, and transition allocation. The emergency relief chain based on government-enterprise coordination that adapts to the evolution of disasters can provide positive actions for integrated precaution and health security.

Factors Challenging the Spiritual Rehabilitation of Iranian Men Affected by Natural Disasters: A Qualitative Study

Spiritual health is one important dimension of human health. Natural disasters, however, can adversely affect human spiritual health. One of the undeniable requirements of disaster management is the spiritual rehabilitation of victims to help them recover to their pre-disaster health conditions. This study aimed to explore the factors challenging the spiritual rehabilitation of Iranian men suffering from natural disasters based on the experiences of key informants. The participants were 19 spiritual health experts in post-disaster spiritual rehabilitation. Participants were selected using a purposive sampling method until data saturation was reached. The data were collected through semi-structured interviews and analyzed using Granheim and Lundman (2004) content analysis method. The factors challenging men's spiritual rehabilitation were classified into 6 main categories and 16 subcategories. The extracted categories included (i) correcting victims' perspectives, (ii) describing God's characteristics, (iii) seeking help from God, (iv) strengthening spiritual beliefs, (v) psychological factors, and (vi) tranquility factors. Our findings identified the important factors challenging the spiritual rehabilitation of the men victimized by natural disasters, which needed to be considered by responsible organizations and health sectors. Particularly, the organizations in charge of disaster management should take necessary measures and plans during the post-disaster phase to restore people's spiritual health. Spiritual health, currently a neglected dimension of health, should be considered people's in parallel with physical, psychological, and social health dimensions. Our results can be helpful in developing action plans for delivering a comprehensive spiritual rehabilitation service, which would help to lead to the full rehabilitation of victims after natural disasters.

A Markov Decision Process Approach for Cost-Benefit Analysis of Infrastructure Resilience Upgrades

As climate change threatens to cause increasingly frequent and severe natural disasters, decisionmakers must consider costly investments to enhance the resilience of critical infrastructures. Evaluating these potential resilience improvements using traditional cost-benefit analysis (CBA) approaches is often problematic because disasters are stochastic and can destroy even hardened infrastructure, meaning that the lifetimes of investments are themselves uncertain. In this article, we develop a novel Markov decision process (MDP) model for CBA of infrastructure resilience upgrades that offer prevention (reduce the probability of a disaster) and/or protection (mitigate the cost of a disaster) benefits. Stochastic features of the model include disaster occurrences and whether or not a disaster terminates the effective life of an earlier resilience upgrade. From our MDP model, we derive analytical expressions for the decisionmaker's willingness to pay (WTP) to enhance infrastructure resilience, and conduct a comparative static analysis to investigate how the WTP varies with the fundamental parameters of the problem. Following this theoretical portion of the article, we demonstrate the applicability of our MDP framework to real-world decision making by applying it to two case studies of electric utility infrastructure hardening. The first case study considers elevating a flood-prone substation and the second assesses upgrading transmission structures to withstand high winds. Results from these two case studies show that assumptions about the value of lost load during power outages and the distribution of customer types significantly influence the WTP for the resilience upgrades and are material to the decisions of whether or not to implement them.

Preparing railway stakeholders against CBRNe threats through better cooperation with security practitioners

This paper presents partial results from the Horizon2020 PROACTIVE project, following a set of literature reviews and surveys conducted with first responder organisations and rail security experts. Qualitative and quantitative data from two surveys are being presented. The results provide an overview of the CBRNe (Chemical, Biological, Radiological, Nuclear and explosive) preparedness and response capabilities of railway stakeholders and how these relate to a wider context represented by CBRNe first responders. The results highlight a set of challenges as well as five core skills that railway staff need to develop or improve: 1) understand the specific characteristics of the CBRNe threat, 2) develop basic response measures, 3) cooperate with authorities and train with specialised first responders, 4) improve public awareness about this threat, and 5) optimise crisis communication. In line with these, project PROACTIVE will further help update rail crisis management plans with practical recommendations concerning the CBRNe threat.

Operationalizing Community Assessment Results to Enhance Preparedness for a Radiological Emergency

OBJECTIVE

A radiological emergency such as the detonation of a radiological dispersal device would have catastrophic health, environmental, and economic consequences. Community assessments can provide useful information about radiological and other emergency preparedness at the household level. Tools such as logic models can be applied to link data collected in a community assessment to planned activities and targeted outcomes. This study sought to answer how public health departments can use the results of a community assessment to improve preparedness for radiological and other types of emergencies and to present a sample logic model demonstrating how questions asked in a community assessment can be used to drive intended outcomes.

DESIGN

Surveys were fielded in 2019 to professionals with experience in radiological emergency preparedness, state and local health and emergency management, and journalism. Questions included the role of health departments in radiological emergency preparedness, the operationalization of results from a community assessment for preparedness, and information sharing in a radiological emergency. Descriptive statistics and a modified framework approach were used for open-ended questions.

RESULTS

Nearly three-fourths of state/local officials reported that it would be at least somewhat difficult (73%; 11 of 15 state/local officials) for a local health department to operationalize the results of a community health assessment for radiological emergency preparedness. Potential barriers included competing priorities, lack of funds, and limited staff. Resources such as pretested communication materials, tailored messaging, and technical tools and training can assist health departments and emergency management agencies in using the information collected from a community assessment.

CONCLUSIONS

To address implementation challenges in operationalizing the results of a community assessment, officials can use tools such as logic models to illustrate how the information gathered from a community health assessment will create an intended preparedness outcome and to advocate for funds for this type of assessment.