Natural disasters have a significant impact on the health sector. On April 25, 2015, Nepal was struck by a 7.8 magnitude earthquake. The aim of the study was to compare patient volumes and clinical conditions presenting to the emergency department pre- and post-earthquake.

A retrospective study was done at Patan Hospital Emergency Department in Kathmandu, Nepal. Volume, demographics, and patient diagnoses were collected for 4 months post-disaster and compared with cases seen the same months the year before the disaster to control for seasonal variations.

After the 2015 Nepal earthquake, 12,180 patients were seen in the emergency department. This was a significant decrease in patient volume compared with the 14,971 patients seen during the same months in 2014 (P=0.04). Of those, 5496 patients (4093 pre-disaster and 1433 post-disaster) had a chief complaint or diagnosis recorded for analysis. An increase in cardiovascular and respiratory cases was seen as well as an increase in psychiatric cases (mostly alcohol related) and cases of anemia. There was a decrease in the number of obstetrics/gynecology, infectious disease, and poisoning cases post-earthquake.

Understanding emergency department utilization after the earthquake has the potential to give further insight into improving disaster preparedness plans for post-disaster health needs. (Disaster Med Public Health Preparedness. 2019;13:211–216).

The purpose of this study was to investigate the 10-year impact of Hurricane Katrina on the incidence of acute myocardial infarction (AMI) along with contributing risk factors and any alteration in chronobiology of AMI.

A single-center, retrospective, comparison study of AMI incidence was performed at Tulane University Health Sciences Center from 2 years before Hurricane Katrina to 10 years after Hurricane Katrina. A 6-year, pre-Katrina and 10-year, post-Katrina cohort were also compared according to pre-specified demographic, clinical, and chronobiological data.

AMI incidence increased from 0.7% (150/21,079) to 2.8% (2,341/84,751) post-Katrina (P<0.001). The post-Katrina cohort had higher rates of coronary artery disease (36.4% vs. 47.9%, P=0.01), diabetes mellitus (31.3% vs. 39.9%, P=0.04), hyperlipidemia (45.4% vs. 59.3%, P=0.005), smoking (34.4% vs. 53.8%, P<0.001), drug abuse (10.2% vs. 15.4%, P=0.02), psychiatric illness (6.7% vs. 14.9%, P<0.001), medication non-adherence (7.3% vs. 15.3%, P<0.001), and lack of employment (7.2% vs. 16.4%, P<0.001). The post-Katrina group had increased rates of AMI during nights (29.8% vs. 47.8%, P<0.001) and weekends (16.1% vs. 29.1%, P<0.001).

Even 10 years after the storm, Hurricane Katrina continues to be associated with increased incidence of AMI, higher prevalence of traditional cardiovascular and psychosocial risk factors, and an altered chronobiology of AMI toward nights and weekends. (Disaster Med Public Health Preparedness. 2019;13:217–222)

Theorists and researchers have linked resilience with a host of positive psychological and physical health outcomes. This paper examines perceptions of resilience and physical health symptoms in a sample of individuals exposed to multiple community disasters following involvement in integrated mental health services.

A multiwave naturalistic design was used to follow 762 adult clinic patients (72% female; 28% minority status), ages 18-92 years (mean age=40 years), who were evaluated for resilience and physical health symptoms prior to receiving services and at 1, 3, and 6 months’ follow-up.

Data indicated increases in perceptions of resilience and decreased physical health symptoms reported over time. Results also indicated that resilience predicted physical health symptoms, such that resilience and physical health symptoms were negatively associated (ie, improved resilience was associated with decreases in physical health symptoms). These effects were primarily observed for those individuals with previous exposure to natural disasters.

Findings provide correlational evidence for behavioral health treatment provided as part of a stepped-care, collaborative model in reducing physical health symptoms and increasing resilience post-disaster. Controlled trials are warranted. (Disaster Med Public Health Preparedness. 2019;13:223–229)

Health care workers performing rescue tasks in large-scale disaster areas are usually challenged in terms of physical and mental endurance, which can affect their lifestyles. Nevertheless, data on whether health care workers tend to adopt healthy lifestyles after disasters are limited. This paper compares the adoption of healthy lifestyle behaviors among health care workers with that among non–health care workers in a postdisaster area.

This cross-sectional observational study was conducted in August 2016. The Health-Promoting Lifestyle Profile II questionnaire was used to interview 261 health care workers and 848 non–health care workers.

Results of the multivariable linear models showed that health care workers had lower physical activity levels (ß=−1.363, P<.0001), worse stress management (ß=−1.282, P<.0001), slower spiritual growth (ß=−1.228, P=.002), and poorer interpersonal relationships (ß=−0.814, P=.019) than non–health care workers. However, no significant differences were found in either nutrition (ß=−0.362, P=.319) or health responsibility (ß=−0.421, P=.283).

Health care workers had less healthy lifestyle behaviors, including physical activity, stress management, spiritual growth, and interpersonal relationships. Further studies are needed to develop health-improving interventions for health care workers in postdisaster areas. (Disaster Med Public Health Preparedness. 2019;13:230–235)

The study aimed to gather data on posttraumatic stress and depression in adolescents following the 2015 Nepal earthquake and explore the adolescents’ coping strategies.

In a questionnaire-based, cross-sectional study about 1 year after the earthquake, adolescents in two districts with different degrees of impact were evaluated for disaster experience, coping strategies, and symptoms of posttraumatic stress and depression measured with the Child Posttraumatic Stress Scale and the Depression Self Rating Scale.

In the studied sample (N=409), the estimated prevalence of posttraumatic stress disorder (PTSD) (43.3%) and depression (38.1%) was considerable. Prevalence of PTSD was significantly higher in the more affected area (49.0% v 37.9%); however, the prevalence figures were comparable in adolescents who reported a stress. The prevalence of depression was comparable. Female gender, joint family, financial problems, displacement, injury or being trapped in the earthquake, damage to livelihood, and fear of death were significantly associated with a probable PTSD diagnosis. Various coping strategies were used: talking to others, praying, helping others, hoping for the best, and some activities were common. Drug abuse was rare. Most of the coping strategies were comparable among the clinical groups.

A considerable proportion of adolescents had posttraumatic stress and depression 1 year after the earthquake. There is a need for clinical interventions and follow-up studies regarding the outcome. Disaster Med Public Health Preparedness. 2019;13:236–242)

Ultimately, a country’s capacity for a large-scale major emergency response will be directly related to the competence of its health care provider (HCP) workforce and communication between emergency responders and hospitals. The purpose of this study was to assess HCP preparedness and service readiness for a major emergency involving mass casualties (mass casualty event or MCE) in Ireland.

A cross-sectional study using a 53-item survey was administered to a purposive sample of emergency responders and HCPs in the Republic of Ireland. Data collection was achieved using the Qualtrics® Research Suite. Descriptive statistics and appropriate tests of comparison between professional disciplines were conducted using Stata 13.

A total of 385 respondents, registered nurses (43.4%), paramedics (37.9%), medical doctors (10.1%), and administrators/managers (8.6%), participated in the study. In general, a level of knowledge of MCEs and knowledge of clinical response activities and self-assessed clinical competence varied drastically across many aspects of the survey. Knowledge and confidence also varied across professional disciplines (P<0.05) with nurses, in general, reporting the least knowledge and/or confidence.

The results demonstrate that serious deficits exist in HCP knowledge, skills, and self-perceived abilities to participate in a large-scale MCE. Results also suggest a poor knowledge base of existing major emergency response plans. (Disaster Med Public Health Preparedness. 2019;13:243–255)

Literature explores which factors most impact resilience and how these factors impact an individual and communities’ ability to cope with disaster. Less research has focused on how age impacts resilience. This research adapts several previous conceptual models used to investigate resilience. To investigate the unique vulnerabilities faced by older individuals in post-disaster settings, this analysis was undertaken to investigate predictors of individual resilience.

Data for the study were derived from the Centers for Disease Control and Prevention (CDC) Gulf States Population Survey (GSPS). The final sample included 5,713 adult residents from 4 gulf-coast states. Multiple linear regression was used for the analysis.

All models (demographic, health, social, and combined) acted as significant predictors of individual resilience. Health and social resilience models accounted for more of the variance in resilience scores. In all models, age was negatively associated with resilience scores. Being female was protective across all models. The results of the model testing indicate inequitable disaster mitigation, with social and health indicators explaining the most variance in the resilience levels.

This research provides practitioners with the knowledge they need to focus their interventions on the areas where it is most needed to empower resilient individuals. (Disaster Med Public Health Preparedness. 2019;13:256–264)

In 2013, the Philippines was struck by typhoon Haiyan, which damaged local hospitals and disrupted health care. The Belgian First Aid and Support Team erected a field hospital and water purification unit in Palo. This study aims to describe the diagnoses encountered and treatment provided.

In this cross-sectional study, medical records of 1267 field hospital patients were reviewed for gender, age, complaints, diagnoses, and management and referral information.

Almost 28% of the patients suffered from injury, but most presented with nonsurgical diseases (64%), particularly of respiratory (31%), dermatological (11%), and digestive (8%) origin. Only 53% presented with disaster-related pathology, and 59% showed signs of infection. Patients needed wound care (47%), pain relief (33%), or antibiotics (29%); 9% needed procedures, 8% needed fluid therapy, and 5% needed psychological support. Children under 5 years of age were more at risk for infections (OR, 18.8; CI, 10.6-33.3) and injuries (OR, 10.3; CI, 6.3-16.8). Males were more prone to injuries than females (OR, 2.1; CI, 1.6-2.6).

One week after the acute phase of a typhoon, respiratory, dermatological, and digestive problems emerge to the prejudice of trauma. Only 53% of patients presented with disaster-related conditions. Young children are more at risk for injury and infectious diseases. These trends should be anticipated when composing Emergency Medical Teams and medical resources to be sent to disaster sites. (Disaster Med Public Health Preparedness. 2019;13:265-278)

Despite emerging evidence of the detrimental effects of natural disasters on maternal and child health, little is known about exposure to tornadoes during the prenatal period and its impact on birth outcomes. We examined the relationship between prenatal exposure to the spring 2011 tornado outbreak in Alabama and Joplin (Missouri) and adverse birth outcomes.

We conducted a retrospective, cross-sectional cohort study using the 2010-2012 linked infant births and deaths data set from the National Center for Health Statistics for tornado-affected counties in Alabama (n=126,453) and Missouri (Joplin, n=6,897). Chi-square and logistic regression analyses were performed to estimate associations between prenatal exposure to tornadoes and birth outcomes.

Prenatal exposure to the tornado incidents did not influence birth weight outcomes. Women exposed to Alabama tornadoes were less likely to have a preterm birth compared to unexposed mothers (OR: 0.93, 95% CI: 0.91, 0.96). Preterm births among Joplin-tornado exposed mothers were slightly higher (13%) compared with unexposed mothers (11.2%). Exposed mothers from Joplin were also more likely to have a cesarean section compared to their counterparts (OR: 1.14, 95% CI: 1.02, 1.26).

We found no association between tornado exposure and adverse birth weight and infant mortality rates. Our findings suggest that prenatal exposure can amplify the odds for a cesarean section. (Disaster Med Public Health Preparedness. 2019;13:279–286)

Rapid response to a trauma incident is vital for saving lives. However, in a mass casualty incident (MCI), there may not be enough resources (first responders and equipment) to adequately triage, prepare, and evacuate every injured person. To address this deficit, a Volunteer First Responder (VFR) program was established.

This paper describes the organizational structure and roles of the VFR program, outlines the geographical distribution of volunteers, and evaluates response times to 3 MCIs for both ambulance services and VFRs in 2000 and 2016.

When mapped, the spatial distribution of VFRs and ambulance stations closely and deliberately reflects the population distribution of Israel. We found that VFRs were consistently first to arrive at the scene of an MCI and greatly increased the number of personnel available to assist with MCI management in urban, suburban, and rural settings.

The VFR program provides an important and effective life-saving resource to supplement emergency first response. Given the known importance of rapid response to trauma, VFRs likely contribute to reduced trauma mortality, although further research is needed in order to examine this question specifically. (Disaster Med Public Health Preparedness. 2019;13:287–294)

Psychological distress is a common symptom after natural disasters. Although musculoskeletal pain also increases after natural disasters, its relation to psychological distress is not known. This study aimed to examine the association of musculoskeletal pain with new-onset psychological distress among survivors of the Great East Japan Earthquake.

A panel study was conducted with survivors at 2 and 3 years after the Great East Japan Earthquake. New-onset psychological distress was defined as psychological distress absent at 2 years and present at 3 years after the disaster. The number of musculoskeletal pain sites at 2 years after the disaster was divided into 3 categories (0, 1, and ≥2). Multivariate logistic regression models were used to calculate the odds ratio and 95% confidence interval for new-onset psychological distress according to the number of musculoskeletal pain sites.

The rate of new-onset psychological distress was 6.7%. Musculoskeletal pain was associated with new-onset psychological distress. Using “0” as a reference, the adjusted odds ratios (95% confidence interval) were 1.65 (0.92-2.95) in “1” and 2.12 (1.24-3.64) in “≥2” (P for trend=.02).

Musculoskeletal pain is associated with new-onset psychological distress among survivors of the Great East Japan Earthquake. (Disaster Med Public Health Preparedness. 2019;13:295–300)

This study examined differences in learning outcomes among newborn intensive care unit (NICU) workers who underwent virtual reality simulation (VRS) emergency evacuation training versus those who received web-based clinical updates (CU). Learning outcomes included a) knowledge gained, b) confidence with evacuation, and c) performance in a live evacuation exercise.

A longitudinal, mixed-method, quasi-experimental design was implemented utilizing a sample of NICU workers randomly assigned to VRS training or CUs. Four VRS scenarios were created that augmented neonate evacuation training materials. Learning was measured using cognitive assessments, self-efficacy questionnaire (baseline, 0, 4, 8, 12 months), and performance in a live drill (baseline, 12 months). Data were collected following training and analyzed using mixed model analysis. Focus groups captured VRS participant experiences.

The VRS and CU groups did not statistically differ based upon the scores on the Cognitive Assessment or perceived self-efficacy. The virtual reality group performance in the live exercise was statistically (P<.0001) and clinically (effect size of 1.71) better than that of the CU group.

Training using VRS is effective in promoting positive performance outcomes and should be included as a method for disaster training. VRS can allow an organization to train, test, and identify gaps in current emergency operation plans. In the unique case of disasters, which are low-volume and high-risk events, the participant can have access to an environment without endangering themselves or clients. (Disaster Med Public Health Preparedness. 2019;13:301–308)

We examined the impact of demographic confounding factors on responses to the Impact of Event Scale–Revised.

Participants were rescue workers aged 20 to 65 years who had responded during the Great East Japan Earthquake in 2011. A multiple indicators, multiple causes model was used to examine associations between covariates and latent factors or items in the Impact of Event Scale–Revised.

Participants were recruited from April to August 2015. The model fit indices in the confirmatory factor analysis and the multiple indicators, multiple causes model suggested an acceptable model fit. Higher education and the Connor-Davidson Resilience Scale score were significantly associated with a decrease in intrusion, avoidance, and hyperarousal. Counseling was significantly associated with increased avoidance. In the direct path model using modification indices, counseling and early arrival were identified as significant covariates.

This study found that higher education and resilience reduced all 3 factors in the Impact of Event Scale–Revised and improved the symptoms of intrusion, avoidance, and hyperarousal. Counseling and early arrival were also associated with improvement in certain items. However, counseling was also linked to increased avoidance and worsening psychophysiological reactions. Further research is recommended to clarify these relationships. (Disaster Med Public Health Preparedness. 2019;13:309–318)