Managing Surges in Demand: A Grounded Conceptual Framework of Surge Management Capability

Surge management is important to hospital operations, yet surge literature has mostly focused on the addition of resources (e.g., 25% more beds) during events like pandemics. Such views are limiting, as meeting surge demands requires hospitals to engage in practices tailored to a surge's unique contingencies. We argue that a dynamic view of surge management should include surge management capability, which refers to how resources are deployed to respond to surge contingencies. To understand this capability, we qualitatively studied five hospital systems experiencing multiple surges due to COVID-19 between April 2020 and March 2022. We develop a framework showing that managing surges involves preserving capacity, expanding capacity, smoothing capacity demand, and enabling surge management. We contribute to surge literature by identifying practices hospitals can adopt to address surges and offering a better understanding of surge conditions (e.g., degree of novelty) that make some surge management practices more appropriate than others.

Disaster preparedness among nurses in disaster-prone countries: A systematic review

BACKGROUND

Disaster preparedness is crucial for mitigating the impact of disasters and saving lives. Ensuring preparedness for disaster response and management, particularly among nurses in disaster-prone countries, is essential due to the serious threats disasters pose to affected populations. This study was conducted to appraise and synthesize the literature examining preparedness for disaster management and response among nurses in countries with the highest disaster risks.

METHODS

A systematic review of the literature published from 2000 onwards was conducted using five databases: SCOPUS, PubMed, MEDLINE, PsychINFO, and CINAHL. Twenty-one relevant articles were identified for this review.

RESULTS

The findings revealed that nurses in countries at high risk of disasters had inadequate disaster knowledge and skills, leaving them ill-prepared to respond to such situations. Previous experience in disaster relief, disaster-related education and training, and higher academic qualifications were associated with increased readiness for disaster response and management.

CONCLUSION

The review's findings provide insight into the current state of disaster preparedness among nurses in disaster-prone nations. The review identified evidence highlighting the value of disaster-related education and training, as well as disaster response experience, in fostering preparedness among nurses. These results can inform policymakers, hospital administrators, and nurse administrators in developing strategies for promoting disaster preparedness in nurses through evidence-based training programs and interventions.

"Jordanian Nurses' Perceptions of Disaster Preparedness and Core Competencies"

OBJECTIVE

This study aims to identify the Jordanian nurses' perception of their disaster preparedness and core competencies.

METHODS

A descriptive, cross-sectional research design was used. The data was collected via an online self-reported questionnaire using the disaster preparedness evaluation tool and the core disaster competencies tool.

RESULTS

A total of 126 nurses participated in the study. Jordanian nurses had moderate to high levels of core disaster competencies and moderate levels of disaster preparedness. Core disaster competencies and disaster preparedness levels differed based on previous training on disaster preparedness and the availability of an established emergency plan in their hospitals. Lastly, a previous training on disaster preparedness and core disaster competencies were statistically significant predictors of disaster preparedness among Jordanian nurses.

CONCLUSIONS

Organizational factors and environmental contexts play a role in the development of such capabilities. Future research should focus on understanding the barriers and facilitators of developing core disaster competencies and disaster preparedness among nurses.

Tailoring Household Disaster Preparedness Interventions to Reduce Health Disparities: Nursing Implications from Machine Learning Importance Features from the 2018-2020 FEMA National Household Survey

Tailored disaster preparedness interventions may be more effective and equitable, yet little is known about specific factors associated with disaster household preparedness for older adults and/or those with African American/Black identities. This study aims to ascertain differences in the importance features of machine learning models of household disaster preparedness for four groups to inform culturally tailored intervention recommendations for nursing practice. A machine learning model was developed and tested by combining data from the 2018, 2019, and 2020 Federal Emergency Management Agency National Household Survey. The primary outcome variable was a composite readiness score. A total of 252 variables from 15,048 participants were included. Over 10% of the sample self-identified as African American/Black and 30.3% reported being 65 years of age or older. Importance features varied regarding financial and insurance preparedness, information seeking and transportation between groups. These results reiterate the need for targeted interventions to support financial resilience and equitable resource access. Notably, older adults with Black racial identities were the only group where TV, TV news, and the Weather Channel was a priority feature for household disaster preparedness. Additionally, reliance on public transportation was most important among older adults with Black racial identities, highlighting priority needs for equity in disaster preparedness and policy.

Use of virtual reality exercises in disaster preparedness training: A scoping review

Background

The scope and number of disasters have increased over the years. This has called for more robust disaster preparedness training and plans. The use of virtual reality exercises in addition to tabletop exercises is considered a new approach to the preparation of disaster preparedness plans. Virtual reality exercises are being developed to either replace or complement current traditional approaches to disaster preparedness training.

Objectives

To review and summarize the current existing literature regarding the effectiveness, advantages and limitations of using virtual reality exercises in disaster preparedness as a complementary/replacement mechanism for real-time drills and tabletop exercises.

Methods

In this scoping review, we searched PubMed, Cochrane, EMBASE, PLOS, and Google Scholar for research publications involving virtual reality exercises in disaster training from 2008 to 2022 using "AND" and "OR" operators for the keywords "disaster," "preparedness," "virtual reality," and "tabletop." From a total of 333 articles that resulted in our search and were then evaluated by the authors, 55 articles were finally included in this review.

Results

Virtual reality exercises are found to be better in the formulation of disaster preparedness plans compared to tabletop exercises. Virtual reality exercises can be used as the primary means of creating a real-life-like experience in disaster preparedness training and proved at least as better complementary to tabletop exercises. Virtual reality exercises have many advantages over traditional real-life or tabletop exercises and are more cost-effective, but some drawbacks are still identified.

Conclusion

The advantages of virtual reality exercises are remarkable and underline their benefits and uses versus costs. We highly encourage decision-makers and institutions dealing in disaster preparedness to adopt using virtual reality exercises in training for disaster preparedness.

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.

The Role of the School Nurse in Addressing Climate-Associated Illnesses: Air Quality

Climate change is having an unprecedented influence on human health. Children's allergies and respiratory problems are increasing because of rising pollen levels and air pollution. School nurses are well positioned to prevent and treat allergies, asthma, and other respiratory conditions. Due to their consistent presence with the school setting, nurses can promote health, wellness, and academic productivity by addressing poor indoor and outdoor air quality. The purpose of this article is to increase understanding of how air quality affects the health of school-age children and to provide school nurses with primary, secondary, and tertiary prevention strategies for ensuring clean and healthy learning environments. This is the second in a series of articles aimed at raising awareness among school nurses about climate-associated illnesses and equipping them with the resources they need to protect students' health.

Social support, educational, and behavioral modification interventions for improving household disaster preparedness in the general community-dwelling population: a systematic review and meta-analysis

Background

The efficacy of household emergency preparedness interventions for community-dwelling, non-institutionalized people is largely unknown.

Objective

To ascertain the state of the science on social support, educational, and behavioral modification interventions to improve all-hazard household disaster preparedness.

Design

Systematic review and meta-analysis.

Methods

Databases, trial registers, reports, and websites were searched, and citation trails followed utilizing replicable methods. Individual, cluster, and cross-over randomized controlled trials of non-institutionalized, community-dwelling populations and non-randomized controlled trials, controlled before-after, and program evaluation studies were included. At least two review authors independently screened each potentially relevant study for inclusion, extracted data, and assessed the risk of bias. Risk of bias was assessed using Cochrane's RoB2 tool for randomized studies and ROBINS-I tool for nonrandomized studies. Meta-analyses were applied using a random-effects model. Where meta-analysis was not indicated, results were synthesized using summary statistics of intervention effect estimates and vote counting based on effect direction. The evidence was rated using GRADE.

Results

17 studies were included with substantial methodological and clinical diversity. No intervention effect was observed for preparedness supplies (OR = 6.12, 95% 0.13 to 284.37) or knowledge (SMD = 0.96, 95% CI -0.15 to 2.08) outcomes. A small positive effect (SMD = 0.53, 95% CI 0.16 to 0.91) was observed for preparedness behaviors, with very low certainty of evidence. No studies reported adverse effects from the interventions.

Conclusion

Research designs elucidating the efficacy of practical yet complex and multi- faceted social support, educational, and behavioral modification interventions present substantial methodological challenges where rigorous study design elements may not match the contextual public health priority needs and resources where interventions were delivered. While the overall strength of the evidence was evaluated as low to very low, we acknowledge the valuable and informative work of the included studies. The research represents the seminal work in this field and provides an important foundation for the state of the science of household emergency preparedness intervention effectiveness and efficacy. The findings are relevant to disaster preparedness practice and research, and we encourage researchers to continue this line of research, using these studies and this review to inform ongoing improvements in study designs.

Factors Contributing to Pharmacies With Good Disaster Preparedness and the Activities of Their Prefectural Pharmaceutical Association: Pharmacies' resilience and associations

OBJECTIVE

Pharmacies have a particularly important responsibility to supply medicine to disaster victims in order to save lives. This study investigated the characteristics of pharmacies that are well prepared for disasters as well as the efforts of the prefectural pharmaceutical association (PPA) to which the pharmacies belong.

METHODS

Questionnaires on matters related to disaster preparedness were mailed to 50 randomly selected pharmacies in each of Japan's 47 prefectures as well as all 47 PPAs in Japan. Logistic regression analysis was performed to examine the association of pharmacy background and the activities of the PPA to which they belong with pharmacy disaster preparedness as well as the association with pharmacies' awareness of disaster preparedness.

RESULTS

Pharmacies in prefectures that conducted disaster preparedness training at least three times a year were better prepared for disasters. In addition, pharmacies with high online utilization and high disaster-preparedness awareness were significantly more prepared for disasters.

CONCLUSIONS

Pharmacies that can promptly provide medicine to disaster victims are considered to be well-prepared for disasters. The results suggest that pharmacy preparedness is also influenced by the disaster preparedness activities of their prefectures.

Dissemination and participation in early warnings and disaster risk reduction in South Africa

Governments cannot effectively manage and handle disasters, particularly at the local community level, without actively engaging vulnerable people. The key to achieving sustainability in disaster recovery is community participation and information dissemination. The informal settlements' lack of access to information and public engagement hampered their ability to recovery, thus prompting this study. Therefore, many cities and intervention partnerships faced information and participation gaps in disaster risk reduction (DRR). The study's rationale was to determine the participation and communication of Khayalitjha household heads, regarding DRR information dissemination for sustainable human settlement, using a cross-sectional household survey of 295 household heads from Khayalitjha in situ informal settlement in the Free State provinces of South Africa. The security of dwelling unit tenure concept was an indirect indicator used to measure social resilience. The key findings revealed that community volunteers, ward committee members and most of the respondents, were responsible for initiating the DRR and disaster preparedness planning process. This indicated that local government needs to strengthen the human resource capacity building for DRR management information dissemination at a local level. The church, school, WhatsApp, Facebook, Twitter and Instagram were the preferred modes of communication for early warnings of disaster information.

Contribution

Despite advocating for a multidisciplinary stakeholder approach, urban DRR studies tend to ignore communities in high disaster-risk areas. Employing social resilience, it aims to extend the DRR information dissemination strategy to in situ informal settlements beyond the communication and public participation advocacy strategies of local municipal urban cities.

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.

Role of the School Nurse in Addressing Climate-Associated Illnesses of School-Age Children

Climate change is associated with global health emergencies. School-age children are particularly susceptible to the health effects associated with climate change. School nurses are uniquely positioned to address children's climate-associated illnesses. This article is the first in a series of articles that aims to inform existing knowledge gaps, raise awareness among school nurses, and equip school nurses with the skills they need to protect the health of school-age children. This series of articles will briefly discuss different aspects of the Impact of Climate Change on Human Health diagram, which was created by the Centers for Disease Control and Prevention.

Disaster preparedness perception, pyschological resiliences and empathy levels of nurses after 2023 Great Turkiye earthquake: Are nurses prepared for disasters: A risk management study

OBJECTIVE

The purpose of the study is to determine the disaster preparedness perceptions, psychological resilences and empathy levels of nurses after 2023 Great Turkiye Earthquake.

METHOD

This descriptive study was conducted in 2023 using with E-Anket. This study was carried out with voluntary participation of 464 nurses living in different geographical regions of Turkiye. The data of the study were obtained utilizing Nurses' Disasters Prepardeness Perception Scale (NDPPS), Pyschological Resileince Scale (PRS) and Empathy Scale (ES).

RESULTS

In this study, the disaster preparedness perception of the nurses was found to be at medium level. More than half of the nurses (65.1%) reported that they did not received any disaster training before. A meaningful was found between the nurses' disaster preparedness perceptions and their empathy levels and psychological resilence.

CONCLUSIONS

As in many countries, it is possible to state that also in Turkiye, the training of nurses for disasters are inadequate and that the studies on this subject are limited. This study will provide a theoretical platform to develop nurses' awareness of disaster preparedness and pyschological resilience and empathic approach programs to increase disaster resilience, and to conduct future research on disaster nursing.

The Role of the School Nurse in Addressing Climate-Associated Illnesses: Mental Well-being

Human health is being impacted by anthropogenic (human-made) climate change. This article describes four ways that climate change may affect mental well-being in school-age children. First, natural disasters-such as more frequent and intense tornadoes and flash floods-may have a direct influence on mental well-being by contributing to acute anxiety and distress. Second, indirect effects of severe weather-including changes in social support systems-may affect mental well-being by increasing isolation. Third, children may suffer feelings of anxiety or depression if they perceive a sense of powerlessness to solve the challenges of a changing climate. Finally, school nurses need to be aware of the emergence of correlations-such as data that suggest increases in temperature may influence the use of inpatient mental health services and suicidal ideations-that require further scientific exploration. This article aims to increase school nurses' understanding of how climate changes may impact the mental well-being of school-age children and to provide strategies for creating a safe, healthy learning environment. This article is the fourth in a series aimed at raising awareness among school nurses about climate-associated illnesses and equipping them with the resources they need to protect school-age children's health.

Disaster Preparedness in Hospitals

Disaster preparedness in hospitals is a critical global concern that involves proactive measures to mitigate the impact of natural or artificial disasters. The review emphasizes the role of organizations such as India's National Disaster Management Authority in the development of response strategies. Hospitals face challenges in protecting facilities and healthcare workers during disasters, highlighting the need for effective training, equipment, and communication access. Differentiating disasters into natural, technological, and artificial types showcases the varied challenges each presents. Key challenges include resource allocation, interoperability of the communication system, evacuation strategies, and ethical considerations. Essential strategies include risk assessment, staff training, communication, and collaboration with external partners. Hospital disaster preparedness requires a comprehensive approach that involves strategies, training, and community participation to ensure safety during emergencies.

Nursing Students' Knowledge, Attitude, and Practice Regarding Disaster Preparedness: A Cross-Sectional Study

Background

Nations are considered to be within at hazard of crises, which create greater challenges for healthcare systems and healthcare workers. Nursing staff and student nurse play a critical role in responding to disasters, and having knowledge and a skill on disasters preparedness is crucial. The aim of the current study was to investigate the nursing students' knowledge, attitude, and practice regarding disaster preparedness.

Methods

A cross-sectional study included a sample of 206 nursing students at College of Applied Medical Sciences in Al-Kharj, Saudi Arabia. Undergraduate students from all years were asked to complete an online questionnaire on knowledge, attitude, and practices regarding disaster preparedness.

Results

The results/findings showed that more than two thirds of the participants had adequate knowledge (69%) and positive attitude (72%) regarding disaster preparedness; however, most of them had inadequate practice (84%). There were statistically significant relations between nursing students' knowledge and their GPA (p = 0.003), students' attitude and their gender (p = 0.014), and students' practice and their age (p = 0.008). Moreover, nursing students' knowledge was positively correlated with their attitude (r = 0.194).

Conclusion and Recommendations

Most of participated students had adequate knowledge and a positive attitude toward disaster preparedness; most of them had inadequate practice. Continuing education and training of student nurse on disaster preparedness is critical to enhance their knowledge and practices; and to be proficient in preparation for and management of any potential disasters or risks. The findings of the current study offer data that would help in the creation of educational policies for student nurse about disaster preparedness.

Portland's Response to the Western North American Heatwave: A Brief Report

BACKGROUND

In June of 2021, a heatwave resulted in high mortality across the Pacific Northwest region. The city of Portland, Oregon, had many advantages: emergency response personnel, science-based policies, political support for climate change adaptation, and collaboration among municipal, county, state, and federal authorities. Though the city's response likely prevented many deaths, heat-related mortality was high.

METHODS

This study presents a retrospective case analysis of the 2021 Western North American Heatwave in Portland, Oregon. Specifically, the study examines the limitations of current heatwave response paradigms by means of a narrative review of the heatwave response and impacts.

RESULTS

Most deaths occurred at home, and most of those who died lived alone. Most of the deceased did not have access to functioning air conditioning.

CONCLUSIONS

Heatwaves exhibit high predictability in the demographics of those most affected and have rising rates of recurrence. Given the effectiveness of residential cooling systems in preventing heat-related mortality, findings suggest that future public health and policy initiatives should put increased focus on the primary prevention of heat exposure.

Running red lights: Risk recognition versus follow-up implementation in the case of Germany's pandemic preparation

The discrepancy between formal arrangements to ensure health security, as assessed in the Global Health Security Index, and COVID-19 outcomes points to a broader problem where formal risk recognition is de-coupled from potentially resource-intensive follow-up policy implementation. Germany is an extreme example of this. Pre-COVID-19, Germany's Federal Office of Civilian Protection conducted two pandemic preparation exercises based on scenarios which closely mirrored the current COVID-19 pandemic: (a) a multi-jurisdictional, multi-agency crisis management exercise assuming a global influenza pandemic and (b) a joint federal and expert-agency based risk-analysis assuming the outbreak of a modified severe acute respiratory symptom virus. While informing legal and institutional reforms, key recommendations on storing personal protective equipment (PPE) and disinfectants for front-line staff were subsequently ignored. PPE shortages initially put staff at risk, led to export restrictions on PPE, and later on hampered the country's ability to address a second wave of the pandemic. This short paper calls for a fuller exploration of factors which hinder ''implementation post-cognition.''.

Winter Storm Uri Reduced Availability of Daily Direct-Care Nurse Staff in Texas Nursing Homes

We examined the effect of Winter Storm Uri on daily direct-care nurse staffing levels in 1,173 Texas nursing homes (NHs) from February 13th to 19th, 2021. We used data from Payroll-Based Journaling and the Care Compare website. Linear mixed effects models were used to estimate the linear and non-linear change in staffing. During Winter Storm Uri, Texas NHs experienced a linear decrease in daily staffing levels with subsequent non-linear increase for registered nurses (RNs; p < .001) and certified nursing assistants (CNAs; p < .001), and staffing increased linearly for licensed practical nurses (LPNs; p < .001). Compared to 1 week before the storm, Texas NHs reported lower staffing levels across all three types of staff, but most dramatically among LPNs and CNAs. In supplemental analyses, urban and lower quality NHs fared slightly poorer than rural and higher-quality NHs. Winter storms pose a particular challenge to NHs and their ability to maintain direct-care nurse staffing levels.

Domains and Psychometric Properties of Scales Measuring Disaster Preparedness among General Population: A Systematic Literature Review

INTRODUCTION

There is no universal tool for measuring disaster preparedness in the general population. This study aimed to provide a summary of the domains and psychometric properties of the available scales that assess preparedness for disasters, or one of its main types, among individuals or households.

METHODS

This study is a systematic review of the literature on disaster preparedness tools. Studies published up to December 2022 were identified through a systematic search of four databases: Google Scholar, PubMed, Scopus, and Web of Science. Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) were used to review and evaluate the psychometric properties. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were used to report this article.

RESULTS

Twelve articles met the inclusion criteria. Among them, five scales measured general disaster preparedness, five measured earthquake preparedness, one measured flood preparedness, and one measured bushfire preparedness. The scales had a number of dimensions ranging from one to six. The most common item topics in the included scales were as follows: having an evacuation plan (n = 7), information source (n = 7), fire extinguisher (n = 6), and emergency kit (n = 5). The scales were rated sufficient for content validity (n = 10), structural validity (n = 5), internal consistency (n = 5), and test-re-test reliability (n = 6). One scale was checked for criterion validity and was rated as insufficient according to the COSMIN guidelines.

CONCLUSION

The findings suggest the need to improve the psychometric properties of the scales, expand their contents, and develop scales relevant to target populations. This study provides useful information for researchers to develop comprehensive assessment tools and valuable sources of items for future scales.

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.

Disaster preparedness and community helping behaviour in the wake of the 2020 Oregon wildfires

Extreme weather events are increasing in frequency and severity owing to climate change. Individual-level behavioural responses-notably, disaster preparedness and community helping actions (such as donating and volunteering)-supplement government efforts to respond to such phenomena, but rarely have they been explored together. Using data from a survey administered soon after the 2020 Oregon wildfires, this paper compares a range of socio-demographic, experiential, attitudinal, and communication-related factors associated with these two individual-level behavioural responses. Findings indicate that respondents who reported experiencing a higher degree of harm and heightened concern about climate change after the wildfires were more likely to report disaster preparedness and community helping actions. Those who reported more frequent informal discussions about the wildfires, consulting more sources to seek information on them, and higher percentages of friends, neighbours, and community members taking actions to prepare for future wildfires also reported more disaster preparedness and community helping actions. Disaster preparedness actions were also positively associated with seeking information from formal/official sources.

Management of Mass-Casualty Incidents in Nepal: A Qualitative Case Study of Three District Hospitals in Nepal

INTRODUCTION

The frequency of disasters world-wide has significantly increased in recent years, leading to an increase in the number of mass-casualty incidents (MCIs). These MCIs can overwhelm health care systems, requiring hospitals to respond quickly and effectively, often with limited resources. While numerous studies have identified the challenges in managing MCIs and have emphasized the importance of hospital disaster preparedness, there is a research gap in the preparedness level and response capacities of district hospitals in Nepal.

STUDY OBJECTIVE

This study attempts to fill this gap by understanding the perception of hospital staff in managing MCIs in district hospitals of Nepal.

METHODS

A qualitative case study was conducted in three district hospitals in Nepal. Semi-structured interviews were conducted with the hospital personnel, using an interview guide. An inductive thematic analysis was carried out to understand their perception on the most recent MCI management.

RESULTS

Three themes emerged from the data analysis: enablers in MCI management, barriers in MCI management, and recommendations for the future. Use of multiple communication channels, mobilization of entire hospital teams, mobilization of police in crowd control, presence of disaster store, and pre-identified triage areas were the major enablers that facilitated successful MCI management. Nonetheless, the study also revealed challenges such as a lack of knowledge on MCI response among new staff, disruptions caused by media and visitors, and challenges in implementing triage.

CONCLUSION

This study emphasized the importance of hospital disaster preparedness in managing MCIs and highlighted the significance of overcoming barriers and utilizing enablers for an efficient response. The findings of this study can provide the basis for the Ministry of Health and Population Nepal and district hospitals to plan initiatives for the effective management of MCIs in the future.

"Is a game really a reason for people to die?" Sentiment and thematic analysis of Twitter-based discourse on Indonesia soccer stampede

This study examined discourses related to an Indonesian soccer stadium stampede on 1st October 2022 using comments posted on Twitter. We conducted a lexicon-based sentiment analysis to identify the sentiments and emotions expressed in tweets and performed structural topic modeling to identify latent themes in the discourse. The majority of tweets (87.8%) expressed negative sentiments, while 8.2% and 4.0% of tweets expressed positive and neutral sentiments, respectively. The most common emotion expressed was fear (29.3%), followed by sadness and anger. Of the 19 themes identified, "Deaths and mortality" was the most prominent (15.1%), followed by "family impact". The negative stampede discourse was related to public concerns such as "vigil" and "calls for bans and suspension," while positive discourse focused more on the impact of the stampede. Public health institutions can leverage the volume and rapidity of social media to improve disaster prevention strategies.

An Ecological Approach to Disaster Mitigation: A Literature Review

Disasters, whether natural or manmade, disrupt the functioning of communities, significantly impacting people's lives and health. To build community resilience, the Centers for Disease Control and Prevention recommends community preparedness, where multiple stakeholders work together. Disaster Preparedness Science Research (DPSR) similarly encourages the improvement of disaster relief outcomes. This literature review assesses the vulnerability of communities for prioritized intervention, summarizes disaster effects, and suggests the scope for improvement in disaster preparedness (DP). Twenty-one articles were reviewed based on disaster mitigation and economic factors from 90 studies identified through a PubMed search till September 2021. Vulnerable communities with higher hazard risks are identified by vulnerability indices (VI), including the Climate Risk Index, Environmental VI, and Socio-Economic VI. However, VI predicting one disaster may not predict another. Disaster behavioral response involves five phases. Disaster effects include medical, mental, environmental, and economic effects, as well as the unique recovery time from each domain effect. Medical effects include malnutrition, malaria, diarrhea, heat stress, exacerbations of chronic conditions, infectious disease outbreaks, trauma, and death. Mental effects are post-traumatic stress disorders, depression, anxiety, somatic complaints, psychological distress, sleep problems, and suicides. Environmental effects include isolation, migration, injury to family members, life threats, and property damage. Loss of livelihood and property are associated with worse outcomes. Disaster recovery, which is seldom measured and not clearly defined, affects measurement and comparison across settings. A uniform validated VI, including multiple indicators assessing vulnerability to various disasters, is required. Livelihood restoration is integral to mental health recovery in some disaster types. Fund diversification, prioritized to the vulnerable and to each domain effect of disaster in the immediate post-disaster phase, expedites recovery. Later recovery investments focused on helping people rebuild their community enhance psychological outcomes. Promoting job insurance in highly vulnerable labor-based communities with high VI, wherein willing-to-pay is high, could facilitate faster recovery. DPSR should be encouraged.

Hospice and Palliative Care during Disasters: A Systematic Review

Providing and maintaining hospice and palliative care during disasters poses significant challenges. To understand the impact of disasters on the provision of hospice and palliative care and the disaster preparedness initiatives in the field, a systematic review was undertaken. Eligibility criteria for the selection of studies were: peer-reviewed original research papers addressing HPC during disasters published between January 2001 and February 2023 in English. The databases CINAHL, MEDLINE, APA PsycInfo, APA PsycArticles, and SocINDEX were searched with textword and MeSh-terms between October 2022 and February 2023. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the studies. Content analysis was performed. The results are presented in the form of a narrative synthesis. Of 2581 studies identified, 57 met the inclusion criteria. Most studies were published recently on the impact of the COVID-19 pandemic. Four main themes were identified in the literature: disruption of the system, setting-specific differences, emotional challenges, and system adaptation. Overall, strategies to tackle hospice and palliative care needs have been poorly integrated in disaster preparedness planning. Our findings highlight the need to strengthen the resilience of hospice and palliative care providers to all types of disasters to maintain care standards.

Disaster Preparedness in K-12 Schools: An Integrative Review

BACKGROUND

The threat of a disaster or potential for a disaster is something that may be experienced by individuals globally. Schools are places of daily mass gatherings which make them an ideal target for mass casualty, natural disasters, and biological incidents.

METHODS

An integrative review using Whittemore and Knafl's model was conducted to explore peer-reviewed publications about K-12 schools and natural disasters and pandemic preparedness and planning.

RESULTS

Themes identified from the systematic review of 12 articles reflected determinants and level of school preparedness, disaster plan components, compliance with government requirements, emergency equipment, supplies, drills, and training, collaboration with outside agencies, and perceptions of school preparedness. Preparedness for disasters and biological events among schools varies and multiple factors contribute to the level of preparedness. Perceptions of school preparedness differ among school community members. Schools perceive more preparedness for disasters than their actual level.

CONCLUSIONS

Our nation's schools are not adequately prepared for disasters. There is a need for further research in schools to identify and understand preparedness for disasters.

Creating realistic nerve agent victim profiles for computer simulation of medical CBRN disaster response

In the last decades, Chemical, Biological, Radiological and Nuclear (CBRN) threats have become serious risks prompting countries to prioritize preparedness for such incidents. As CBRN scenarios are very difficult and expensive to recreate in real life, computer simulation is particularly suited for assessing the effectiveness of contingency plans and identifying areas of improvement. These computer simulation exercises require realistic and dynamic victim profiles, which are unavailable in a civilian context. In this paper we present a set of civilian nerve agent injury profiles consisting of clinical parameters and their evolution, as well as the methodology used to create them. These injury profiles are based on military injury profiles and adapted to the civilian population, using sarin for the purpose of illustration. They include commonly measured parameters in the prehospital setting. We demonstrate that information found in military sources can easily be adjusted for a civilian population using a few simple assumptions and validated methods. This methodology can easily be expanded to other chemical warfare agents as well as different ways of exposure. The resulting injury profiles are generic so they can also be used in tabletop and live simulation exercises. Modeling and simulation, if used correctly and in conjunction with empirical data gathered from lessons learned, can assist in providing the evidence practices for effective and efficient response decisions and interventions, considering the contextual factors of the affected area and the specific disaster scenario.

Pediatric Behavioral Health during the COVID-19 Pandemic: Expert Advice for Preparedness, Response, and Recovery

The COVID-19 pandemic exacerbated the child mental health crisis and existing disparities. Child anxiety, depression, suicide attempts and completions, and mental-health-related emergency department visits significantly increased. In response to this crisis, the Administration for Strategic Preparedness and Response (ASPR) developed behavioral health task forces associated with funded pediatric centers of disaster excellence. The Health Resources and Services Administration (HRSA) funded the Pediatric Pandemic Network (PPN) to prepare for future endemics and pandemics, with behavioral health identified as a priority in mitigation, preparedness, response, and recovery. This commentary provides insights from pediatric disaster preparedness and response behavioral health subject matter experts. Our roles have been to identify how to build behavioral health professional competencies across disciplines and various medical settings and to strengthen emergency interdisciplinary behavioral health care capability regionally and at the national level. Specific examples of interdisciplinary training and demonstration projects are included as models for enhancing behavioral health situational awareness and developing curricula to support preparedness and response for the current ongoing pandemic and future natural and biological disasters. This commentary also includes a call to action for workforce development to move beyond a boots-on-the-ground mentality for pediatric behavioral health disaster preparedness and response toward a more inclusive role for behavioral health providers of varied specialties. This means that behavioral health providers should become more informed of federal programs in this area, seek further training, and find innovative ways to collaborate with their medical colleagues and community partners.

Applying Lessons Learned from the COVID-19 Pandemic to Future Threats to the Perinatal Care System

INTRODUCTION

Health care systems will continue to face unpredictable challenges related to climate change. The COVID-19 pandemic tested the ability of perinatal care systems to respond to extreme disruption. Many childbearing people in the United States opted out of the mainstream choice of hospital birth during the pandemic, leading to a 19.5% increase in community birth between 2019 and 2020. The aim of the study was to understand the experiences and priorities of childbearing people as they sought to preserve a safe and satisfying birth during the time of extreme health care disruption caused by the pandemic.

METHODS

This exploratory qualitative study recruited participants from a sample of respondents to a national-scope web-based survey that explored experiences of pregnancy and birth during the COVID-19 pandemic. Maximal variation sampling was used to invite survey respondents who had considered a variety of birth setting, perinatal care provider, and care model options to participate in individual interviews. A conventional content analysis approach was used with coding categories derived directly from the transcribed interviews.

RESULTS

Interviews were conducted with 18 individuals. Results were reported around 4 domains: (1) respect and autonomy in decision-making, (2) high-quality care, (3) safety, and (4) risk assessment and informed choice. Respect and autonomy varied by birth setting and perinatal care provider type. Quality of care and safety were described in relational and physical terms. Childbearing people prioritized alignment with their personal philosophies toward birth as they weighed safety. Although levels of stress and fear were elevated, many felt empowered by the sudden opportunity to consider new options.

DISCUSSION

Disaster preparedness and health system strengthening should address the importance childbearing people place on the relational aspects of care, need for options in decision-making, timely and accurate information sharing, and opportunity for a range of safe and supported birth settings. Mechanisms are needed to build system-level changes that respond to the self-expressed needs and priorities of childbearing people.

Evidence of Disaster Planning by Home Care Providers: An Integrative Literature Review

The increasing risk of disasters worldwide poses challenges both to health care infrastructures and to home care providers, who must maintain decentralised services for those in need of long-term care for as long as possible, even under adverse circumstances. However, both the kind of organisational precautions that home care providers consider in preparation for disasters and the available evidence on the effectiveness of these precautions remain largely unclear. An integrative literature review was thus performed via a systematic search of several international databases in order to identify original research on organisational disaster planning by home care providers and to determine the evidence base of this research. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Of the 286 results, 12 articles met the inclusion criteria and presented results from nine studies on disaster planning. Three overarching types of activities carried out by home care providers were identified inductively. The overall scientific quality of the studies was moderate, and none investigated the effectiveness of disaster planning by home care providers. Despite the variety of possible activities that home care providers already consider, evidence on how to make organisational disaster planning effective and sustainable remains lacking.

Hospital Disasters Preparedness for Mass-Casualty Incidents at Emergency Units in Northwest of Ethiopia: A Cross-Sectional Study

BACKGROUND

Ethiopian policy and strategy aim to make health care systems capable of dealing with emergencies. However, Ethiopian health care still lacks a comprehensive "all-hazard" approach and a disaster preparedness program. Thus, this study aimed to assess the level of disaster preparedness in selected public hospitals for mass-casualty incidents (MCIs) in Amhara Regional State, Northwest Ethiopia.

METHODS

A descriptive cross-sectional study was conducted at general and comprehensive specialized hospitals (CSHs) in Amhara Regional State, Ethiopia using a World Health Organization (WHO) hospital emergency response checklist that included a domain on mass-casualty management (MCM) adapted from a literature review.

RESULTS

Seventeen (17) hospitals were evaluated (response rate: 81%). Five (29.4%) were teaching hospitals (tertiary health care) and 12 (70.5%) were non-teaching (secondary health care) hospitals. With an average mean of 97.3 (SD = 33.68; range 31-160), most hospitals under WHO required an Acceptable level of preparedness. Two were at an Unacceptable (0-67) level of preparedness, 12 (70.5%) hospitals were at an Insufficient (68-134) state, while the other three had an Acceptable (135-192) level of preparedness.

CONCLUSION

The preparedness level of hospitals is Insufficient for potential MCIs in this region and needs prior attention in implementing existing strategic guidelines to develop and activate hospital disaster plans if and when needed.

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

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

Disaster Preparedness and Awareness among University Students: A Structural Equation Analysis

Students have long been among those most emotionally and physically affected by natural or manmade disasters, yet universities and colleges continue to lack effective disaster response and mitigation practices. This research identifies how students' socio-demographics and disaster preparedness indicators (DPIs) impact their awareness of the dangers of disasters and their ability to survive and cope with the changes that disasters bring. A comprehensive survey was designed and distributed to university students to gain an in-depth understanding of their perceptions of disaster risk reduction factors. A total of 111 responses were received, and the impact of the socio-demographics and DPIs on the students' disaster awareness and preparedness were evaluated by employing structural equation modeling. The results indicate that the university curriculum impacts the disaster awareness of students while the establishment of university emergency procedures impacts the disaster preparedness of students. The purpose of this research is to enable university stakeholders to identify the DPIs that are important to the students so that they can upgrade their programs and design effective DRR courses. It will also aid policymakers in redesigning effective emergency preparedness policies and procedures.

The relationship between knowledge and disaster preparedness of undergraduates responding to forest fires

Forest and land fires are disasters that regularly occur on the island of Kalimantan, Indonesia. Higher education students on the island of Kalimantan are considered vulnerable to these disasters, hence the need for mandatory disaster knowledge and preparedness for every individual in the area. This research aimed to: (1) determine disaster knowledge and student preparedness in dealing with forest and land fire disasters, (2) determine the relationship between knowledge and student preparedness. This study used a quantitative correlation method with a questionnaire. The data were processed using the Statistical Package for the Social Sciences 21. The research sample used purposive sampling because it followed the needs of the study, which involved 300 students affected by forest fires, representing three universities located in a forest fire-prone area in West Kalimantan province, Indonesia. Each campus has 100 students, a total of 300 students. The results showed as many as 284 students had experienced forest and land fire disasters. In addition, 202 out of 284 students were known to have low disaster knowledge. Four main parameters of disaster preparedness were used to measure student preparedness, namely (1) knowledge and attitudes, (2) emergency response plans, (3) disaster warning system and (4) resource mobilisation. The number of students with high preparedness was 141, while 143 had low preparedness. Thus, student preparedness measures need to be increased to avoid disaster impact.

CONTRIBUTION

Based on the data analysis, students' knowledge and preparedness to face forest fires are positively related. It was shown that the higher the learning of students, the higher their readiness and vice versa. It is suggested that there is a need for increasing knowledge and preparedness actions for students in dealing with forest fire disasters through regular disaster lectures, simulations and training so that they can make the right decisions in coping with disasters.

Comparison of the Level of Disaster Preparedness Between Private and Government Hospitals in Saudi Arabia: A Cross-Sectional Study

OBJECTIVE

The objective of this study was to describe and compare almost all the components of disaster preparedness between private and government hospitals in the Eastern Province of the Kingdom of Saudi Arabia, using the World Health Organization's (WHO) checklist.

METHODS

We assessed and compared the disaster preparedness between government and private hospitals in Province, using the 10-key component WHO checklist in a descriptive cross-sectional study. Of 72 hospitals in the region, 63 responded to the survey.

RESULTS

All 63 hospitals had an HDP plan and reported having a multidisciplinary HDP committee. In all responding hospitals, HDP was acceptable in most indicators of preparedness; however, some hospitals to some extent fell short of preparedness in surge capacity, equipment and logistic services, and post-disaster recovery. Government and private hospitals were generally comparable in disaster preparedness. However, government hospitals were more likely to have HDP plans that cover WHO's "all-hazard" approach, both internal and external disasters, compared to private hospitals.

CONCLUSION

HDP was acceptable, however, preparedness in surge capacity, equipment and logistic services, and post-disaster recovery fell short. Government and private hospitals were comparable in preparedness with regards to all indicators except surge capacity, post-disaster recovery, and availability of some equipment.

Factors Influencing Hospitals' Disaster Preparedness in the Eastern Province of Saudi Arabia

OBJECTIVE

The study aimed to identify the factors that influence the disaster preparedness of hospitals and validate an evaluation framework to assess hospital disaster preparedness (HDP) capability in the Eastern Province of Saudi Arabia.

METHODS

A cross-sectional survey of all hospitals (n = 72) in the Eastern Region of Saudi Arabia was conducted. A factor analysis method was used to identify common factors and validate the evaluation framework to assess HDP capacity.

RESULTS

Sixty-three (63) hospitals responded to the survey. A 3-factor structure was identified as key predicators of HDP capacity. The first factor was the most highly weighted factor, which included education and training (0.849), monitoring and assessing HDP (0.723), disaster planning (0.721), and command and control (0.713). The second factor included surge capacity (0.708), triage system (0.844), post-disaster recovery (0.809), and communication (0.678). The third factor represented safety and security (0.638) as well as logistics, equipment, and supplies (0.766).

CONCLUSION

The identified 3-factor structure provides an innovative approach to assist the operationalization of the concept of HDP capacity building and service improvement, as well as serve as a groundwork to further develop instrument for assessing HDP in future studies.

Community Resilience After Hurricanes: Can Neuman's Systems Theory Guide Public Health Nursing?

Objective: Examination of community resilience after Hurricane Harvey and -applicability of Neuman's systems model to the role of public health nurses in applying primary, secondary, and tertiary prevention strategies to communities susceptible to natural disasters. Design: Descriptive, exploratory study. Sample: A convenience sample (N = 1,470). Measurements: Hurricane Harvey Survey. Results: Respondents from seven counties in southeast Texas report previously experiencing a hurricane (80%) with no weather-related flooding (79%), adequate preparation (54%), failure to comprehend the potential severity of Hurricane Harvey (62%), damage to their homes (45%), and a 68% loss of personal belongings. Anxiety, frustration, disbelief, determination, and hopefulness were rated highest after the storm. Residents received updates from family and friends, social media, and online news reports regarding rising water, even though, in many cases, a mandatory evacuation was not officially announced. Only 35% of respondents reported being aware of resources available, possibly due to flooding or inaccessibility of typical resources (e.g., hospitals, shelters). Communicating through social networks (social media, family, and friends) provided avenues for arranging evacuations and assistance. Respondents report giving assistance to others and receiving assistance from family, friends, and their faith community. The majority of respondents reported that the community provided adequate services during the hurricane (59%), and they plan to stay in southeast Texas (70%). Conclusions: Southeast Texas residents demonstrated individual and community resilience which may be further supported with primary, secondary, and tertiary nursing interventions as illustrated by Neuman's systems model. The rise in positive emotional response traits demonstrates positive coping, which is consistent with resilience. Effective and timely communication through social networks provides an additional line of resistance to protect and promote the resilience of the community. The lack of medical resources indicates a break in the normal line of defense and an area for potential improvement with the utilization of mobile medical units to provide healthcare for areas not easily accessible during a disaster. Public health nurses are strategically positioned in the international community to lead prevention and recovery efforts by applying theory-based community interventions.

Understanding Mothers' Worries about the Effects of Disaster Evacuation on Their Children: A Cross-Sectional Study

In Japan, there is an imminent threat of major earthquakes and floods. Children's health is increasingly at risk from climate-change-related disasters. The purpose of this study was to identify factors related to mothers' worries about the effects of evacuation on their children. Participants were mothers whose children attended a childcare center in one municipality in Ishikawa, Japan. A cross-sectional design was used. A questionnaire was developed based on previous studies, and it was used to conduct a survey. A total of 1298 individuals who provided valid data were included in the analysis. The following factors were related to mothers' worries about the effects of evacuation on their children: not having prepared a grab bag as a disaster risk reduction strategy, having no neighbors to help them in case of disaster, having children aged <3 years, and having children with allergies. The mothers of children <3 years old with allergies who are unprepared and have no social support are likely to worry about evacuating their children. Policymakers must be aware that the mothers of children aged <3 years and the mothers of children with allergies experience substantial concerns about the effects of evacuation on their children.

Exploring U.S. Food System Workers' Intentions to Work While Ill during the Early COVID-19 Pandemic: A National Survey

With "stay at home" orders in effect during early COVID-19, many United States (U.S.) food system workers attended in-person work to maintain national food supply chain operations. Anecdotally, many encountered barriers to staying home despite symptomatic COVID-19 illness. We conducted a national, cross-sectional, online survey between 31 July and 2 October 2020 among 2535 respondents. Using multivariable regression and free-text analyses, we investigated factors associated with workers' intentions to attend work while ill (i.e., presenteeism intentions) during the early COVID-19 pandemic. Overall, 8.8% of respondents intended to attend work with COVID-19 disease symptoms. Almost half (41.1%) reported low or very low household food security. Workers reporting a higher workplace safety climate score were half as likely to report presenteeism intentions (adjusted odds ratio [aOR] 0.52, 95% confidence interval (CI) 0.37, 0.75) relative to those reporting lower scores. Workers reporting low (aOR 2.06, 95% CI 1.35, 3.13) or very low (aOR 2.31, 95% CI 1.50, 3.13) household food security levels had twice the odds of reporting presenteeism intentions relative to those reporting high/marginal food security. Workplace culture and safety climate could enable employees to feel like they can take leave when sick during a pandemic, which is critical to maintaining individual and workplace health. We stress the need for strategies which address vulnerabilities and empower food workers to make health-protective decisions.

Assessing Thai Hospitals’ Evacuation Preparedness Using the Flexible Surge Capacity Concept and Its Collaborative Tool

According to the concept of “flexible surge capacity,” hospitals may need to be evacuated on two occasions: (1) when they are exposed to danger, such as in war; and (2) when they are contaminated, such as during the Covid-19 pandemic. In the former, the entire hospital must be evacuated, while in the latter, the hospital becomes a pandemic center necessitating the transfer of its non-contaminated staff, patients, and routine activities to other facilities. Such occasions involve several degrees of evacuation—partial or total—yet all require deliberate surge planning and collaboration with diverse authorities. This study aimed to investigate the extent of hospital evacuation preparedness in Thailand, using the main elements of the flexible surge capacity concept. A mixed method cross-sectional study was conducted using a hospital evacuation questionnaire from a previously published multinational hospital evacuation study. The tool contained questions regarding evacuation preparedness encompassing surge capacity and collaborative elements and an open-ended inquiry to grasp potential perspectives. All 143 secondary care, tertiary care, and university hospitals received the questionnaire; 43 hospitals provided responses. The findings indicate glitches in evacuation protocols, particularly triage systems, the inadequacies of surge planning and multiagency collaboration, and knowledge limitations in community capabilities. In conclusion, the applications of the essential components of flexible surge capacity allow the assessment of hospital preparedness and facilitate the evaluation of guidelines and instructions through scenario-based training exercises.

Exploring mutual support awareness in Japanese communities: A pilot study

OBJECTIVE

The study aimed to examine life situations and perceptions related to the recognition of mutual support among Japanese people.

DESIGN

A quantitative, correlational, cross-sectional analysis.

SAMPLE

Nine hundred and nine participants who provided complete questionnaire responses.

MEASUREMENTS

As a disaster prevention measure, a community center conducted a "questionnaire survey evaluating the recognition of mutual support and several potentially related factors". In our study, these data from a self-administered questionnaire were used secondarily.

RESULTS

The perceptions that differed with regard to the sense of mutual support included family structure; satisfaction with support, security, and disaster prevention in the district; being able to ask for help with shopping; closeness of the relationship with one's neighbors; seeing oneself as providing or needing protection; and recognition of existing worries regarding evacuation. In a logistic regression model, the factors predicting the sense of mutual support included being younger than 70 years, being able to ask for help with shopping, and the closeness of the association with one's neighbors.

CONCLUSIONS

The study identified situations that might predict the sense of mutual support in individuals in Japanese communities.

A framework to assess potential health system resilience using fuzzy logic

Objectives

To develop and test a framework to assess the potential of public health systems to maintain a resilient performance.

Methods

Quantitative data from public databases and qualitative data from technical reports of Brazilian health authorities were used to develop the framework which was assessed and modified by experts. Fuzzy logic was used for the mathematical model to determine scores for four resilient abilities - monitoring, anticipation, learning, and response - and an aggregated coefficient of resilient potential in health care. The coefficient measures used data from before the coronavirus disease 2019 (COVID-19) pandemic. These were compared with measures of the actual performance of health systems in 10 cities in Brazil during the pandemic.

Results

The coefficient of resilient potential in health care showed that the cities most affected by COVID-19 had lower potential for resilient performance before the pandemic. Some local health systems had adequate response capabilities, but other abilities were not well developed, which adversely affected the management of the spread of COVID-19.

Conclusions

The coefficient of resilient potential in health care is useful to indicate important areas for resilient performance and the different types of resilience capacities that can be considered in different contexts and levels of public health systems. Regular assessment of the potential of health systems for resilient performance would help highlight opportunities for continuous improvement in health system functions during chronic stress situations, which could strengthen their ability to keep functioning in the face of sudden disturbances.

Assessment of disaster preparedness and related impact factors among emergency nurses in tertiary hospitals: descriptive cross-sectional study from Henan Province of China

Background

The aim of this study was to investigate the current state of disaster preparedness and to determine associated factors among emergency nurses from tertiary hospitals in Henan Province of China.

Methods

This multicenter descriptive cross-sectional study was conducted with emergency nurses from 48 tertiary hospitals in Henan Province of China between September 7, 2022-September 27, 2022. Data were collected through a self-designeds online questionnaire using the mainland China version of the Disaster Preparedness Evaluation Tool (DPET-MC). Descriptive analysis and multiple linear regression analysis were used to evaluate disaster preparedness and to determine factors affecting disaster preparedness, respectively.

Results

A total of 265 emergency nurses in this study displayed a moderate level of disaster preparedness with a mean item score of 4.24 out 6.0 on the DPET-MC questionnaire. Among the five dimensions of the DPET-MC, the mean item score for pre-disaster awareness was highest (5.17 ± 0.77), while that for disaster management (3.68 ± 1.36) was the lowest. Female gender (B = -9.638, p = 0.046) and married status (B = -8.618, p = 0.038) were negatively correlated with the levels of disaster preparedness. Five factors positively correlated with the levels of disaster preparedness included having attended in the theoretical knowledge training of disaster nursing since work (B = 8.937, p = 0.043), having experienced the disaster response (B = 8.280, p = 0.036), having participated in the disaster rescue simulation exercise (B = 8.929, p = 0.039), having participated in the disaster relief training (B = 11.515, p = 0.025), as well as having participated in the training of disaster nursing specialist nurse (B = 16.101, p = 0.002). The explanatory power of these factors was 26.5%.

Conclusion

Emergency nurses in Henan Province of China need more education in all areas of disaster preparedness, especially disaster management, which needs to be incorporated into nursing education, including formal and ongoing education. Besides, blended learning approach with simulation-based training and disaster nursing specialist nurse training should be considered as novel ways to improve disaster preparedness for emergency nurses in mainland China.

Optimizing Disaster Preparedness Planning for Minority Older Adults: One Size Does Not Fit All

By 2050, one in five Americans will be 65 years and older. The growing proportion of older adults in the U.S. population has implications for many aspects of health including disaster preparedness. This study assessed correlates of disaster preparedness among community-dwelling minority older adults and explored unique differences for African American and Hispanic older adults. An electronic survey was disseminated to older minority adults 55+, between November 2020 and January 2021 (n = 522). An empirical framework was used to contextualize 12 disaster-related activities into survival an0000000d planning actions. Multivariate logistic regression models were stratified by race/ethnicity to examine the correlates of survival and planning actions in African American and Hispanic older adults, separately. We found that approximately 6 in 10 older minority adults did not perceive themselves to be disaster prepared. Medicare coverage was positively associated with survival and planning actions. Income level and prior experience with disaster were related to survival actions in the African American population. In conclusion, recognizing the gaps in disaster-preparedness in elderly minority communities can inform culturally sensitive interventions to improve disaster preparedness and recovery.

The Emergency Medical Team Operating System: design, implementation, and evaluation of a field hospital information management system

In case of sudden-onset disasters (SODs), the World Health Organization deploys specialized emergency medical teams (EMTs); yet, the coordination and operation of such teams pose significant challenges. One issue is the lack of digital information systems and standards. We developed a highly customizable and scalable electronic medical record (EMR) system, tailored to EMT requirements, called the "Emergency Medical Team Operating System" (EOS). EOS was successfully tested through 9 realistic clinical tasks during a full-scale EU Module Exercise. During the initial evaluation, 21 team members from 9 countries evaluated the system positively, stressing the urgent need for an EMR for EMTs. EMTs face unique challenges during disaster relief missions. To provide an effective and coordinated delivery of care, there is a great need for an EMR tailored to the specific needs of EMTs. EOS may serve as an effective EMR during SOD missions.

Collaborative Interprofessional Health Science Student Led Realistic Mass Casualty Incident Simulation

In collaboration, a health science university and a fire department offered a mass casualty incident (MCI) simulation. The purpose of this study was to evaluate a cross-section of student health care providers to determine their working knowledge of an MCI. Students were given a pretest using the Emergency Preparedness Information Questionnaire (EPIQ) and the Simple Triage and Rapid Transport (START) Quiz. The EPIQ instrument related to knowledge of triage, first aid, bio-agent detection, critical reporting, incident command, isolation/quarantine/decontamination, psychological issues, epidemiology, and communications. The START Quiz gave 10 scenarios. Didactic online content was given followed by the simulation a few weeks later. A posttest with the same instruments was given after the simulation. Participants were majority female (81.7%), aged between 25-34 (41.7%), and 61.7% (n = 74) had undergraduate or post-graduate degrees. The overall pretest mean was 2.92 and posttest mean was 3.64. The START Quiz found participants struggled to correctly assign triage levels. Students also experienced challenges correctly assigning patients to specific triage categories. Findings will assist educators to understand knowledge gaps, so revisions can be made to enhance learning in disaster management. Concentration in proper field triage is also a needed focus.

Nursing During a Disaster Starts With Education

Future nurses, both entry level and advanced practice, are pivotal to the nation's disaster response. They are critical frontline, acute, primary, and public health workers in the United States and internationally. To respond well, they must be taught how to prepare and intervene appropriately. This preparation is multidimensional and includes not only concrete knowledge but mental, emotional, and ethical preparation for the realities of working and providing care while affected by chaos. Training should be experiential and reflective and expose students to the interprofessional nature of disaster planning and response. New nurses, as they enter practice, as the COVID-19 pandemic has demonstrated, may also take on the role of a frontline disaster responder. The ability to effectively respond and access available resources to care for patients is required. Schools of nursing and nursing faculty increasingly will be required to include disaster preparedness as an integral part of the nursing curriculum.

Role of the Advanced Practice Registered Nurse in Crisis Response

As clinical leaders, advanced practice registered nurses are often called upon to respond to crises. Although frameworks for emergency preparedness and response have been established by the National Organization of Nurse Practitioner Faculties and the International Council of Nurses, the advanced practice registered nurse community is not consistently prepared to participate in crisis response. Merging of the previously established frameworks allows identification of additional opportunities for advanced practice registered nurses to be educated and engaged in emergency preparedness and all-hazards response, including preparation activities, communication, safety and security, incident management, assessment, intervention, and recovery. Additional areas of focus are leadership, ethics, and end-of-life care. Use of the existing frameworks combined with the lessons learned from the COVID-19 response can empower advanced practice registered nurses to improve their readiness to respond to future crises.