Disaster Medicine and Public Health Preparedness最新文献

Objective: In March 2019, flooding of the Missouri River and its tributaries destroyed infrastructure and farmland and affected communities, including those in the state of Nebraska. The objective of this study was to assess emergency preparedness and satisfaction with flood response, recovery, and relief efforts 5 years following the 2019 floods in rural eastern Nebraska.

Methods: Using stratified simple random sampling, this study surveyed 13 Nebraska communities to assess emergency preparedness and satisfaction with flood response, recovery, and relief efforts 5 years following the 2019 Missouri River Flood. Descriptive statistics are reported.

Results: Households impacted by the 2019 Nebraska flood reported worsening physical and mental health symptoms and identified major gaps in communication, long-term mental health support, and infrastructure resilience. Self-reported preparedness improved post-flood. Inadequate early warnings and poor information dissemination eroded trust.

Conclusions: There are persistent mental and physical health impacts resulting from exposure to the 2019 Missouri River floods that can impact communities' ability to respond and recover from subsequent hazards. Evaluating the impacts of previous disasters is a critical component of increasing community resiliency and local public health and emergency preparedness capacity to serve these populations.

Medical shelters are frequently utilized after major disasters to care for displaced individuals with severe mobility limitations and chronic medical conditions that may be inadequately addressed in general population sheltering. A retrospective chart review was conducted on 680 patients served in state-operated Medical Needs Shelters (MNS) in Louisiana following three major hurricanes from 2020 to 2021. The authors aimed to produce a descriptive analysis of the degree and variety of medical complexity of patients within the shelters to guide future shelter planning. Data illustrate demographic characteristics, clinical attributes, and outcomes among shelter patients. Patients were found to have numerous medical comorbidities, often with serious concomitant neuropsychiatric, cardiovascular, and pulmonary conditions. The shelter population was highly dependent on nursing staff for medication management and activities of daily living. They also had high utilization of respiratory therapies, hemodialysis, and wound care. Clinically significant events (e.g., falls, mental status changes, vital sign abnormalities), often resulting in transport to local hospitals, occurred in approximately 20% of all patient stays. Limitations of the study include suspected underreporting of disease prevalence and the study's retrospective approach. Public health planners should consider the clinical needs of this population when designing strategic and tactical approaches to mass care for medically vulnerable individuals. Future research might examine which factors place individuals at higher risk for decompensation within a medical shelter.

Introduction: Operational Canines are highly trained and valuable animals that support emergency and disaster response efforts, such as Search and Rescue, scene security, and recovery operations. While working, Operational Canines often encounter dangerous operational and environmental situations.

Discussion: To maintain their health and operational readiness, it is critical that Operational Canines receive regular wellness care before entering the field and emergency treatment when necessary in the field.

Limitations: Nevertheless, the most common first responders to Operational Canine field emergencies-Canine Handlers, Law Enforcement Officers, and Emergency Medical Service personnel-often have limited species-specific medical training, and there are no nationally standardized training programs.

Conclusion: This article proposes a nationally standardized program to train first responders, specifically Canine Handlers, Law Enforcement Officers, and Emergency Medical Service personnel on Operational Canine wellness management and emergency medical care at a level tailored to participants' knowledge and skill sets. Finally, this article discusses recent legal trends relating to OpK9 emergency medical care, which highlight the pressing need for a nationally standardized training program.

Objective: This study aims to elucidate the ethical dilemmas faced by pre-hospital emergency medical service personnel during disaster triage, with a specific focus on the Kahramanmaraş Earthquakes, and to document their experiences.

Materials and methods: This phenomenological study employed semi-structured interviews with 29 pre-hospital emergency medical service workers who served during the first 72 hours of the Kahramanmaraş Earthquakes to gather qualitative data. Purposeful sampling was used for face-to-face interviews, and MAXQDA20 was utilized for content analysis.

Results: The main themes encompassed problems related to disaster management organization, environmental factors, and individual factors. Environmental factors, such as coordination deficiencies at the scene, jurisdictional confusion, security concerns, and seasonal conditions, as well as personal factors including education and experience, were pivotal in the occurrence of ethical dilemmas in disaster triage.

Conclusion: Pre-hospital emergency medical services personnel affected by the disaster faced more ethical dilemmas. The presence of many affected children had a profound emotional impact on participants, leading to more frequent ethical dilemmas, particularly in the application of black code protocols.

Objective: This research explores the legal and jurisdictional frameworks governing the deployment of Australian WHO-classified Emergency Medical Teams (EMTs) in Asia-Pacific disaster responses, focusing on how these factors influence authorization, timeliness, scope of practice, and legal risks.

Methods: A scoping review was conducted using thematic document analysis, comparative legal analysis, and case studies anchored in specific jurisdictions. Sixty-one publicly available sources were reviewed, including legal instruments, national disaster laws, bilateral agreements, and reports from recent EMT missions.

Results: EMTs face fragmented legal environments. Host-country sovereignty primarily determines authorization, but the mechanisms for expedited licensure, customs clearance, and legal protection are often lacking. WHO classification provides no overarching legal standing during international deployments. Other barriers include immigration rules, drug regulations, and inconsistent data protection laws. Case studies highlight gaps in bilateral agreements and inconsistent credential recognition.

Conclusions: Despite improved technical standards, legal uncertainty hampers EMT effectiveness, including legal risk exposure. Countries should establish bilateral frameworks, regional licensing systems, embedded legal support, and standardized data governance. These steps are critical for ensuring timely, safe, and lawful EMT operations during international disasters.

Objective: To prevent power lines from igniting wildfires, utility companies in California are authorized to conduct Public Safety Power Shutoffs (PSPS), de-energizing, or shutting off power to equipment during periods of high wildfire risk. This study assessed the association between PSPS and emergency department visits.

Methods: The study quantified the extent to which counties in California experienced PSPS each day between September 15 and November 30, 2019. Linear mixed models were used to estimate the rate of emergency department encounters per 100,000 county residents based on quartiles of PSPS exposure, compared to no PSPS exposure at the county-day level. Analyses examined all emergency department encounters as well as age- and diagnosis-specific visits.

Results: There was an increase of 15 emergency department visits per 100,000 persons aged 65 years and older on days with the highest levels of PSPS exposure compared to days without PSPS. The highest level of PSPS exposure was associated with increased rates of emergency department visits for respiratory, cardiovascular, injury, and mental or behavioral diagnoses.

Conclusions: Despite advanced notification, PSPS events are associated with negative health consequences. Older adults are particularly vulnerable to the unintended adverse health effects of PSPS and should be prioritized in mitigation efforts.

Purpose: Assessing hospital preparedness for nuclear and radiological threats is one of the most effective methods for evaluating the condition of hospitals in relation to such incidents. This study aimed to review the tools used to assess hospital preparedness for nuclear and radiological threats and to analyze the strengths and weaknesses of these instruments.

Materials and methods: In this systematic review, the full texts of 98 studies identified through database searches and 7 studies identified through manual searches were reviewed. Data were extracted from studies that addressed the measurement tools for assessing hospital preparedness for nuclear and radiological threats from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The content quality of the tools was evaluated based on the World Health Organization (WHO) preparedness criteria, and the psychometric properties of the tools were examined using the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) study criteria.

Results: Among the studies reviewed, only 21 met the inclusion criteria, within which 9 tools for assessing hospital preparedness were identified. Eight tools directly assessed vulnerability in terms of physical space, related equipment, and hospital personnel, while one tool used a different criterion as an indicator of hospital preparedness for nuclear and radiological threats. The findings showed that most of the tools focused solely on evaluating a hospital's vulnerability in terms of physical space, equipment, and personnel, with insufficient attention given to other critical aspects such as protocols, triage, and other important issues.

Conclusion: Given the limitations of existing tools in terms of psychometric evaluation, the lack of theoretical models, the reliance on empirical findings for tool design, and considering the critical importance of measuring and assessing hospital preparedness for nuclear and radiological threats, there is a pressing need in the health sector for the development of scientific tools based on the experiences of process owners and hospital specialists. These tools should adhere to rigorous processes of instrument development and validation.

Introduction: Case study has been frequently conducted in disaster-related research, yet the trends and patterns of disaster-related case study are unclear. This large-scale analysis aimed at better understanding their thematic focus and reporting practices.

Methods: Based on systematic search strategy, publication metadata from 1901 to 2023 were obtained from Elsevier/Scopus and analyzed. Structural topic modeling was employed to identify the focus areas of the topics. The number of topics was determined based on content and diagnostic metrics such as held-out likelihood and semantic coherence. Hierarchical clustering was used to categorize the identified topics. The contents and reporting styles of the most-cited articles within each topic were further analyzed.

Results: This large-scale analysis included 18,782 publications, showing an increase in number. The number of topics was determined as 12. They grouped into 2 overarching categories: public health and social medicine; and earth science and environmental technology. There were variabilities in reporting.

Conclusions: This study highlighted a growing trend in the publication of disaster-related case studies across diverse thematic areas. As variabilities in reporting exist, there is a need for standardization in reporting to enhance transparency in disaster-related case study.

Background: Exercises are an essential component of preparedness and should be used to enhance capability and contribute to continuous improvement. An exercise can be as simple as a planning group discussing an emergency plan or as complex as a major multi-agency event involving several organizations and participants. This study aims to identify and conceptualize quality indicators (QIs) influencing prehospital disaster exercises across structure, conduct, and outcome.

Methods: This research was conducted through a systematic review and searching of the databases of PubMed, Scopus, Web of Science, and Google Scholar. Thematic content analysis was used for data analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for systematic search, and the Critical Appraisal Skills Program (CASP) was used for quality assessment of the final extracted articles.

Results: From an initial set of 3,083 articles, 10 high-quality studies were included for analysis. The quality indicators influencing prehospital disaster exercises were analyzed into 3 themes, 8 categories, and 21 subcategories. The primary themes and related main categories included: Exercise structure QIs (knowledge promotion and cognitive skills, supply of exercise hardware and software requirements and resources desirable management), Exercise conduct QIs (practical proficiency in essential skills and decision-making capacity), and Exercise outcome QIs (evaluation and reporting of exercise, promotion of managerial capabilities and competencies, and development of psychological capabilities).

Conclusion: The findings of this research present a knowledge framework that can help exercise planners in prehospital settings in designing scientifically sound and standardized exercises aimed at enhancing disaster response processes. Furthermore, the implementation and evaluation of both discussion-based and operation-based disaster exercises informed by these identified quality indicators can foster the development of knowledge and promote behavioral change among prehospital staff, and facilitate a standardized response to emergencies and disasters.