Disaster Medicine and Public Health Preparedness最新文献

Objective: To develop an evaluative framework for assessing the emergency response capabilities of higher education institutions to major emerging infectious diseases, enabling institutions to identify preparedness gaps and prioritize improvements across the outbreak lifecycle.

Methods: The Haddon Matrix was used as the foundation for the framework. A Delphi study with a Likert scale was conducted, followed by the Analytic Hierarchy Process (AHP) to determine the importance of the indicators.

Results: A consensus was reached on the evaluation system, comprising 3 primary indicators: prevention and preparedness, response and handling, and recovery and rehabilitation. These indicators were further divided into 11 secondary and 34 tertiary indicators. Expert authority coefficients were 0.82 and 0.80, and Kendall's coefficients were 0.32 and 0.161 (P < 0.001). AHP highlighted prevention and preparedness as the highest-priority domain (weight = 0.426), followed by recovery and rehabilitation (0.326). High-priority items included safety knowledge dissemination, emergency command systems, primary prevention, and timely warning and monitoring.

Conclusions: Integrating the Haddon matrix, Delphi consensus, and AHP, this study delivers a validated, prioritized framework to assess universities' MEID response capability across phases. External validity beyond Shanghai remains to be established; cross-regional applicability should be empirically tested through multi-site validation, broader stakeholder representation, and evaluation of technology-enabled components, particularly in resource-limited settings.

Introduction: Children are uniquely vulnerable to chemical, biological, radiological, and nuclear (CBRN) events due to anatomical, physiological, and psychological differences. Current decontamination practices are adapted from adult protocols.

Objective: To evaluate current practices, challenges, and special considerations in pediatric decontamination during CBRN events.

Method: A scoping review was conducted using six databases in accordance with PRISMA-ScR framework. Studies were eligible if they evaluated decontamination methods involving children (0-18 years) in real or simulated CBRN scenarios. Fourteen studies met the inclusion criteria, and data were thematically analyzed into four domains.

Results: Disrobing is widely recognized as a critical first step in the decontamination process, and 43% of the studies reviewed identified it as such. When done immediately and appropriately, it can remove a significant amount of contaminants. Although its effectiveness varies based on how much of the body is covered and the nature of the exposure. Dry decontamination was discussed in 21% of studies, and wet decontamination was the most commonly reported approach, appearing in 93%. Key pediatric challenges included hypothermia, psychological distress, separation from caregivers, and difficulties managing non-ambulatory or special needs populations. Few studies addressed age-specific protocols or long-term psychological impacts. The results are presented in procedural order to reflect the typical sequence of decontamination in CBRN response.

Conclusions: Current decontamination guidelines inadequately address pediatric-specific needs. There is a critical need for standardized, age-appropriate guidelines that integrate caregiver support and psychosocial considerations. A pediatric decontamination algorithm was developed to consolidate current evidence into a practical framework for CBRN mass casualty incidents.

The recent conflict in the Middle East posed unprecedented threats, with hundreds of long-range ballistic missiles launched toward Israel, targeting military and civilian facilities including hospitals. Organizational and logistic actions were taken in Sheba Medical Center, both pre-emptively and during the conflict, preparing for a mass casualty incident while maintaining routine medical care to the population and maintaining safety of patients and staff. These included discharging patients and increasing home hospitalizations, ward evacuations, transferring patients to protected areas, and classifying patients by their vulnerability and status of protection, accelerated structural adaptation of underground spaces to house patients, and construction of a tented field hospital underground. An effective command and control system was in place to monitor protective status, and an ethical committee was convened to assist in decision-making. These measures enabled continued delivery of emergency and medical care under fire while ensuring the safety of patients and staff.

Aim: To assess the iodine status of pregnant women from disadvantaged groups in Kahramanmaraş Province 1 year after the earthquake, including factors affecting iodine status.

Methods: 510 healthy pregnant women were included in the study. A questionnaire was given to pregnant women after the earthquake to assess changes in diet and other social factors. Thyroid function, autoantibodies, thyroglobulin, urinary iodine concentration (UIC), creatinine (Cr) levels, and ultrasound were measured. Thyroid ultrasound was also performed to assess thyroid volume.

Results: The median UIC of the participants was 91.27 μg/g Cr (Q1-Q3 = 62.53-142.86). The rate of low iodine status (<150 μg/g Cr) was 77.3% and the incidence of goiter was 19.2%. After the earthquake, 69% of pregnant women lived in urban areas and 31% in rural areas. 11.8% of the areas where they lived were moderately damaged, 11.4% severely damaged, and 5.9% completely destroyed. 15.1% were still living in temporary shelters 1 year after the earthquake. The risk of low UIC was 2.2 times higher for those living in temporary shelters after the earthquake.

Conclusions: Temporary shelters after the earthquake were the main risk factor for low iodine status. We need to support these groups after disasters and reduce the number of people living in temporary shelters.

Objective: Due to frailty, chronic health issues, limited mobility, dependence on assistive devices, and polypharmacy, the geriatric population is more susceptible to the adverse effects of earthquakes. The aim of this study was to determine the factors affecting the quality of life of older adults who experienced the Kahramanmaraş-centered earthquakes in Türkiye on February 6, 2023.

Methods: This cross-sectional interview-based study was conducted with 340 older adults who experienced the earthquakes on February 6, 2023, and visited outpatient departments in Gaziantep. Data were gathered using a demographic form, Modified Fried Frailty Index, and WHO Quality of Life Instrument for Older Adults.

Results: Participants' average age was 71.37 ± 6.56 years, and 56.6% were women. Among them, 20.9% lost a first-degree relative, 15.3% were injured, and 45.3% were displaced. WHOQOL-OLD scores differed significantly by age, marital status, education, chronic illness, polypharmacy, living arrangements, and frailty.

Conclusions: This study highlights the factors influencing the quality of life of older adults in Türkiye after an earthquake. Living with a spouse and having primary or secondary education improved quality of life, while chronic illnesses and displacement had negative impacts. These findings emphasize the importance of considering the specific needs of older adults in disaster preparedness and response.

Objectives: This study aimed to evaluate the impact of temporary housing challenges (THC) after the February 6, 2023, Türkiye earthquake on clinical follow-up non-adherence (CFNA), low-density lipoprotein cholesterol (LDL-C) target achievement, and major adverse cardiac events (MACE) in patients with myocardial infarction (MI).

Methods: A retrospective cohort of 283 MI patients undergoing coronary angiography and stenting between May 6 and November 6, 2023, was analyzed. Patients were divided into Group 1 (THC group: residing in container cities) and Group 2 (non-THC group: living in intact/usable homes). Initial laboratory parameters and 1-year MACE incidence were compared. In MACE-free patients, adherence to 5 scheduled face-to-face visits (week 1, months 1, 3, 6, and 12) and LDL-C goal achievement were evaluated. CFNA was defined as attending fewer than 3 visits. One-year lab results were also compared.

Results: THC independently predicted CFNA (OR: 1.925, P = 0.019) and MACE (OR: 3.937, P = 0.006). Follow-up attendance was lower in Group 1 (week 1: 43.2% vs 69.9%, P <0.001; month 12: 82.2% vs 95.1%, P = 0.008). LDL-C target achievement was significantly lower (6.85% vs 31.07%, P <0.001).

Conclusions: THC adversely impacts clinical follow-up adherence and increases MACE rates. Addressing THC's challenges is essential for improving post-disaster health care outcomes.

Objectives: The January 2025 Los Angeles wildland-urban interface wildfires represent a significant environmental disaster, resulting in widespread evacuations. Beyond the immediate physical and economic devastation, wildfires can have profound and lasting impacts on the mental well-being of affected populations. This study compared mental health outcomes between Southern California residents who evacuated due to the fires and those who did not evacuate.

Methods: Southern California residents (N = 739) were surveyed 2-3 months after the January 2025 wildfires. Logistic regression models assessed the association of evacuation status with depression, anxiety, and PTSD, adjusting for demographics and baseline pre-fire levels of depression and anxiety.

Results: Evacuating was significantly associated with higher odds of depression (AOR = 1.75 [1.08-2.85]) and PTSD (AOR = 2.44 [1.36-4.35]), after controlling for pre-fire mental health status and other demographic covariates. Evacuation status was not associated with anxiety.

Conclusions: These findings support previous research linking wildfire exposure to adverse mental health outcomes and highlight the importance of targeted mental health screening and support for wildfire evacuees, who are at increased risk for depression and PTSD.

Objective: This study explored Italian Emergency Medical Services (EMS) professionals' perceptions regarding a hypothetical wearable device during Mass Casualty Incidents (MCIs), aiming to improve MCI management and patient outcomes. The device includes patient identifier, vital sign monitoring, LED-based triage coding, geolocation, and real-time data transmission. Using the Technology Acceptance Model (TAM), perceived usefulness, perceived ease of use, and behavioral intention to use the device were measured.

Methods: An anonymous online survey was distributed to the 67 EMS dispatch centers across Italy. After an introduction to the device, participants answered demographic and TAM-based questions using a seven-point scale.

Results: Among the 141 respondents, most were males (60.3%), nurses (66.7%), and reported over 10 years of EMS experience (63.1%); 51.8% had prior MCI response experience. The wearable device was positively rated for improving situational awareness and coordination, with concerns about workflow integration and potential rescue delays. The questionnaire showed high internal reliability (Cronbach's α = 0.96). Principal Component Analysis (PCA) highlighted distinct perceptions between features supporting scene coordination and those enhancing triage accuracy.

Conclusions: The study highlights the perceived value of the wearable in improving MCI coordination and situational awareness. However, concerns regarding workflow integration and possible rescue delays warranted further research on real-world application.