Eight million American children under the age of 5 attend daycare and more than another 50 million American children are in school or daycare settings. Emergency planning requirements for daycare licensing vary by state. Expert opinions were used to create a disaster preparedness video designed for daycare providers to cover a broad spectrum of scenarios.

Various stakeholders (17) devised the outline for an educational pre-disaster video for child daycare providers using the Delphi technique. Fleiss κ values were obtained for consensus data. A 20-minute video was created, addressing the physical, psychological, and legal needs of children during and after a disaster. Viewers completed an anonymous survey to evaluate topic comprehension.

A consensus was attempted on all topics, ranging from elements for inclusion to presentation format. The Fleiss κ value of 0.07 was obtained. Fifty-seven of the total 168 video viewers completed the 10-question survey, with comprehension scores ranging from 72% to 100%.

Evaluation of caregivers that viewed our video supports understanding of video contents. Ultimately, the technique used to create and disseminate the resources may serve as a template for others providing pre-disaster planning education. (Disaster Med Public Health Preparedness. 2019;13:123–127)

This study seeks to determine the capacity of community primary care practices to meet the needs of patients during public health emergencies and to identify the barriers and resources necessary to participate in a coordinated response with public safety agencies.

The self-administered web-based survey was distributed in January 2014 via e-mail to primary care providers in Pennsylvania using the listservs of several professional societies.

A total of 179 primary care providers participated in the survey. In total, 38% had practice continuity of operations plan in place and 26% reported that they had a plan for patient surge in the outpatient setting. Thirty percent reported that they were registered on the state Health Alert Network and 41% said they were able to communicate with patients during disasters. Only 8% of providers reported that they believed that their patients with special health care needs were prepared for a disaster, although over two-thirds of responding practices felt they could assist these patients with disaster preparedness. Providers indicated that more information regarding government agency plans and community resources, patient education materials, and more time to devote to counseling during patient encounters would improve their ability to prepare their patients with special health care needs for disasters. Providers also reported that they would benefit from partnerships to help the practice during emergencies and communications technology to reach large numbers of patients quickly.

Community-based primary care practices can be useful partners during public health emergencies. Efforts to promote continuity of operations planning, improved coordination with government and community partners, as well as preparedness for patients with special health care needs, would augment their capabilities and contribute to community resilience. (Disaster Med Public Health Preparedness. 2019;13:128–132).

Torrential rainfall and flooding from September 2-6, 2014 submerged >350 villages in Jammu and Kashmir state. We conducted rapid needs assessment in capital Srinagar from 27 September to 1 October to assess population health and safety needs.

Based on Community Assessment for Public Health Emergency Response (CASPER) methodology, we selected 7 households each from 30 census blocks using 2-stage cluster sampling. We collected information on demographics, needs, and illnesses using structured questionnaire.

Of the 210 households surveyed, an estimated 57% (CI: 41%-73%) reported significant damage, 50% (CI: 36%-63%) were evacuated, and 16% (CI: 10%-22%) reported injuries. Households lacked electricity (22%; CI: 8.8%-36%), tap water (13%; CI: 5%-21%), working toilets (11%; CI: 4%-19%), and adequate food supply (14%; CI: 8%-20%). Moreover, 55% (CI: 45%-64%) of households reported cough, cold, fever, rashes, or diarrhea; 68% (CI: 59%-77%) experienced agitation, anxiety, depression, or nightmares since the flooding. Of the households with a member on medicines for non-communicable diseases, 40% did not have a week’s supply. Restoring basic essentials (30%; CI: 22%-37%) and repairing houses (30%; CI: 19%-40%) were the most urgent needs expressed.

Floods damaged >1/2 of households in Srinagar, disrupting basic essentials, and causing mental trauma. These findings helped authorities prioritize assistance with psychological symptoms and availability of prescription medicines. (Disaster Med Public Health Preparedness. 2019;13:133–137)

The objective of the study was to research the basic seismic response capability (BSRC) of hospitals in Lima Metropolitana. A large number of wounded could be registered in case of an earthquake; therefore, operational hospitals are necessary to cure the injured. The study focused on the operational performance of the hospitals, autonomies of essential resources such as power, water, medical gases, and medicine, in addition to the availability of emergency communication system and ambulances.

Data by a probabilistic seismic risk analysis have been used to assess the operational level of the hospitals. Subsequently, availability of an essential resource has been combined with the immediately operational hospitals to evaluate the BSRC of the health facilities.

Forty-one of Lima’s hospitals have been analyzed for a seismic event with 72-100 years of a return period. Three hospitals (7.3%) were capable to work in a self-sufficient manner for 72 hours, another three (7.3%) for 24 hours, and one (2.4%) for 12 hours.

Results showed a low performance of the hospitals in case of an earthquake. The issue is due to the high seismic vulnerability of the existing structures. Given the importance of Lima city in Peru, structural and nonstructural retrofitting plans should be implemented to improve the preparedness of the health system in case of an emergency. (Disaster Med Public Health Preparedness. 2019;13:138–143)

While carrying out a scoping review of earthquake response, we found that there is no universal standardized approach for assessing the quality of disaster evidence, much of which is variable or not peer reviewed. With the lack of a framework to ascertain the value and validity of this literature, there is a danger that valuable insights may be lost. We propose a theoretical framework that may, with further validation, address this gap.

Existing frameworks – quality of reporting of meta-analyses (QUORUM), meta-analysis of observational studies in epidemiology (MOOSE), the Cochrane assessment of bias, Critical Appraisal Skills Programme (CASP) checklists, strengthening the reporting of observation studies in epidemiology (STROBE), and consensus guidelines on reports of field interventions in disasters and emergencies (CONFIDE)–were analyzed to identify key domains of quality. Supporting statements, based on these existing frameworks were developed for each domain to form an overall theoretical framework of quality. This was piloted on a data set of publications from a separate scoping review.

Four domains of quality were identified: robustness, generalizability, added value, and ethics with 11 scored, supporting statements. Although 73 out of 111 papers (66%) scored below 70%, a sizeable portion (34%) scored higher.

Our theoretical framework presents, for debate and further validation, a method of assessing the quality of non-traditional studies and thus supporting the best available evidence approach to disaster response. (Disaster Med Public Health Preparedness. 2019;13:147–151)

The study aimed to examine impact of think-tanks designed to create policies for emerging threats on medical teams’ perceptions of individual and systemic emergency preparedness.

Multi-professional think-tanks were established to design policies for potential attacks on civilian communities. In total, 59 multi-sector health care managers participated in think-tanks focused on: (a) primary care services in risk zones; (b) hospital care; (c) casualty evacuation policies; (d) medical services to special-needs populations; and (e) services in a “temporary military-closed zone.” Participants rotated systematically between think-tanks. Perceived individual and systemic emergency preparedness was reviewed pre-post participation in think-tanks.

A significant increase in perceived emergency preparedness pre-post-think-tanks was found in 8/10 elements including in perceived individual role proficiency (3.71±0.67 vs 4.60±0.53, respectively; P<0.001) and confidence in colleagues’ proficiency during crisis (3.56±0.75 vs 4.37±0.61, respectively; P<0.001). Individual preparedness and role perception correlates with systemic preparedness and proficiency in risk assessment.

Participation in policy-making impacts on individuals’ perceptions of empowerment including trust in colleagues’ capacities, but does not increase confidence in a system’s preparedness. Field and managerial officials should be involved in policy-making processes, as a means to empower health care managers and improve interfaces and self-efficacy that are relevant to preparedness and response for crises. (Disaster Med Public Health Prepardness. 2019;13:152–157)

One of the most important measures following disasters is setting up a communicable disease surveillance system (CDSS). This study aimed to develop indicators to assess the performance of CDSSs in disasters.

In this 3-phase study, firstly a qualitative study was conducted through in-depth, semistructured interviews with experts on health in disasters and emergencies, health services managers, and communicable diseases center specialists. The interviews were analyzed, and CDSS performance assessment (PA) indicators were extracted. The appropriateness of these indicators was examined through a questionnaire administered to experts and heads of communicable diseases departments of medical sciences universities. Finally, the designed indicators were weighted using the analytic hierarchy process approach and Expert Choice software.

In this study, 51 indicators were designed, of which 10 were related to the input (19.61%), 17 to the process (33.33%), 13 to the product (25.49%), and 11 to the outcome (21.57%). In weighting, the maximum score was that of input (49.1), and the scores of the process, product, and outcome were 31.4, 12.7, and 6.8, respectively.

Through 3 different phases, PA indicators for 4 phases of a chain of results were developed. The authors believe that these PA indicators can assess the system’s performance and its achievements in response to disasters. (Disaster Med Public Health Preparedness. 2019;13:158–164)

To determine whether there were incremental mental health impacts, specifically on depression trajectories, as a result of the 2008 economic crisis (the Great Recession) and subsequent Hurricane Sandy.

Using latent growth mixture modeling and the ORANJ BOWL dataset, we examined prospective trajectories of depression among older adults (mean age, 60.67; SD, 6.86) who were exposed to the 2 events. We also collected community economic and criminal justice data to examine their impact upon depression trajectories. Participants (N=1172) were assessed at 3 times for affect, successful aging, and symptoms of depression. We additionally assessed posttraumatic stress disorder (PTSD) symptomology after Hurricane Sandy.

We identified 3 prospective trajectories of depression. The majority (83.6%) had no significant change in depression from before to after these events (resilience), while 7.2% of the sample increased in depression incrementally after each event (incremental depression). A third group (9.2%) went from high to low depression symptomology following the 2 events (depressive-improving). Only those in the incremental depression group had significant PTSD symptoms following Hurricane Sandy.

We identified a small group of individuals for whom the experience of multiple stressful events had an incremental negative effect on mental health outcomes. These results highlight the importance of understanding the perseveration of depression symptomology from one event to another. (Disaster Med Public Health Preparedness. 2019;13:173–182)

The purpose of the study is to describe changes in mental health among women following an oil spill and to examine their association with the Deepwater Horizon oil spill (DHOS).

The Women and Their Children’s Health study followed 2038 women in Louisiana after the DHOS. Subjects were interviewed in 2012-2014 and 2014-2016. Oil spill exposure was characterized using survey items about economic and physical exposures. Outcomes were depressive symptoms and mental distress.

After adjustment for relevant demographics, depressive symptoms increased over 2 time points following the DHOS, whereas symptoms of mental distress decreased. For every year increase in time since the DHOS, the rate ratio for depressive symptoms increased by a factor of 1.08. In contrast, the rate ratio for mental distress decreased by a factor of 0.97. In addition, initial associations between economic and physical exposure to the DHOS persisted up to 6 years after the spill; women who were more highly exposed experienced higher levels of depressive symptoms (rate ratios ranged from 1.08 to 1.11) and mental distress (rate ratios from 1.05 to 1.11) at each time point than women who were less exposed.

A better understanding of recovery patterns following an oil spill can help direct critical mental health response efforts. (Disaster Med Public Health Preparedness. 2019;13:183–190)

Disasters place unprecedented demands on emergency medical services and can test paramedics personal commitment as health care professionals. Despite this challenge, guidelines and codes of ethics are largely silent on the issue, providing little to no guidance on what is expected of paramedics or how they ought to approach their duty to treat in the face of risk. The objective of this research is to explore how paramedics view their duty to treat during disasters.

The authors employed qualitative methods to gather Australian paramedic perspectives.

Our findings suggest that paramedic decisions around duty to treat will largely depend on individual perception of risk and competing obligations. A code of ethics for paramedics would be useful, but ultimately each paramedic will interpret these suggested guidelines based on individual values and the situational context.

Coming to an understanding of the legal issues involved and the ethical-social expectations in advance of a disaster may assist paramedics to respond willingly and appropriately. (Disaster Med Public Health Preparedness. 2019;13:191–196)

Researchers have been evaluating several approaches to assess acute radiation injury/toxicity markers owing to radiation exposure. Keeping in mind this background, we assumed that whole-body irradiation in single fraction in graded doses can affect the antioxidant profile in skin that could be used as an acute radiation injury/toxicity marker.

Sprague-Dawley rats were treated with CO-60 gamma radiation (dose: 1-5 Gy; dose rate: 0.85 Gy/minute). Skin samples were collected (before and after radiation up to 72 hours) and analyzed for glutathione (GSH), glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), and lipid peroxidation (LPx).

Intra-group comparison showed significant differences in GSH, GPx, SOD, and CAT, and they declined in a dose-dependent manner from 1 to 5 Gy (P value<0.01, r value: 0.3-0.5). LPx value increased (P value<0.01, r value: 0.3-0.5) as the dose increased, except in 1 Gy (P value>0.05).

This study suggests that skin antioxidants were sensitive toward radiation even at a low radiation dose, which can be used as a predictor of radiation injury and altered in a dose-dependent manner. These biochemical parameters may have wider application in the evaluation of radiation-induced skin injury and dose assessment. (Disaster Med Public Health Preparedness. 2019;13:197–202).