Hurricane Sandy made landfall in New Jersey on October 29, 2012, resulting in widespread power outages and gasoline shortages. These events led to potentially toxic exposures and the need for information related to poisons/toxins in the environment. This report characterizes the New Jersey Poison Information and Education System (NJPIES) call patterns in the days immediately preceding, during, and after Hurricane Sandy to identify areas in need of public health education and prevention.

We examined NJPIES case data from October through December 2012. Most Sandy-related calls had been coded as such by NJPIES staff. Additional Sandy-related cases were identified by performing a case narrative review. Descriptive analyses were performed for timing, case frequencies, exposure substances, gender, caller site, type of information requests, and other data.

The most frequent Sandy-related exposures were gasoline and carbon monoxide (CO). Gasoline exposure cases were predominantly males and CO exposure cases, females (P < 0.0001). Other leading reasons for Sandy-related calls were poison information, food poisoning/spoilage information, and water contamination.

This analysis identified the need for enhanced public health education and intervention to improve the handling of gasoline and encourage the proper use of gasoline-powered generators and cleaning and cooking equipment, thus reducing toxic exposures.

A disaster in the hospital is particularly serious and quite different from other ordinary disasters. This study aimed at analyzing the activity outcomes of a disaster medical assistance team (DMAT) for a fire disaster at the hospital.

The data which was documented by a DMAT and emergent medical technicians of a fire department contained information about the patient’s characteristics, medical records, triage results, and the hospital which the patient was transferred from. Patients were categorized into four groups according to results of field triage using the simple triage and rapid treatment method.

DMAT arrived on the scene in 37 minutes. One hundred and thirty eight (138) patients were evacuated from the disaster scene. There were 25 patients (18.1%) in the Red group, 96 patients (69.6%) in the Yellow group, and 1 patient (0.7%) in the Green group. One patient died. There were 16 (11.6%) medical staff and hospital employees. The injury of the caregiver or the medical staff was more severe compared to the family protector.

For an effective disaster-response system in hospital disasters, it is important to secure the safety of medical staff, to utilize available medical resources, to secure patients’ medical records, and to reorganize the DMAT dispatch system.

Rural Long-term Care (LTC) providers face unique challenges when planning, preparing for, and responding to disasters. We sought to better understand challenges and identify best practices for LTC in rural areas.

Case studies including key informant interviews and site visits were conducted with LTC staff and emergency planning, preparedness, and response partners in three rural communities. Themes were identified across sites using inductive coding.

Communication across disaster phases continues to be a challenge for LTC providers in rural communities for all disaster types. Communication challenges limit LTC providers’ ability to address patient needs during emergencies and limit the resilience of providers and patients to future disasters. Limited coordination among local leadership and LTC providers prevents dissemination of information, resources, and services, and slows response and recovery time. Including LTC providers as stakeholders in planning and exercises may improve communication and coordination.

More than two decades into efforts to increase preparedness of health care systems to all hazards, rural LTC facilities still face challenges related to communication and coordination. Agencies at the federal, state, and local level should include input from rural LTC stakeholders to address gaps in communication and coordination and increase their disaster resilience.

The aim of this study is to determine the demographic and clinical characteristics associated with the need for long-term treatment in a child psychiatry facility.

Demographic characteristics, diagnosis, source of referral, time elapsed between the earthquake and the request for care, and the treatment prescribed in the baseline assessment were compared between a group of subjects that required long-term treatment (LTT) and a group that was discharged after a brief intervention (D).

A total of 171 patients were seen, and 27% of the subjects required LTT. In general, these subjects were younger, referred from highly affected areas, presented a delay in seeking care, and were mainly diagnosed with anxiety and stress-related disorders.

These findings suggest the need for research regarding the design of mental health programs for the early detection of psychopathology after natural disasters in children and adolescents.

Disaster health literacy is vital for emergency medicine and public health preparedness. Conversely, how health and safety information is communicated has a significant impact on disaster health literacy. A lack of alignment between the disaster response and the public’s reaction was apparent during a Dutch chemical incident. This case study aims to provide insights into why that misalignment occurred.

The case study used readily available Twitter data. The tweets represented both the public and the authorities. The tweets were coded, thematically categorised, analysed, and synthesised to generate an explanatory framework describing the obstacles experienced during the emergency.

The analysis identified four areas of concern with regards to the lack of alignment between the authorities and the public: the alert of the chemical incident, the inadequate communication, the problematic disaster management, and the insufficient disaster health literacy.

The case study showed shortcomings in communication and a lack of alignment in the emergency response of the authorities as well as the public’s disaster health literacy. Immediate action points were apparent, and a more profound evaluation is recommended to avoid further escalation of an emergency in the future. Trust needs to be built before the next incident strikes.

In this study, we aimed to evaluate the correlation between the trauma score of individuals wounded in the Lushan earthquake and emergency workload for treatment. We further created a trauma score-emergency workload calculation model.

We included data from patients wounded in the Lushan earthquake and treated at West China Hospital, Sichuan University. We calculated scores per the following models separately: Revised Trauma Score (RTS), Prehospital Index (PHI), Circulation Respiration Abdominal Movement Speech (CRAMS), Therapeutic Intervention Scoring System (TISS-28), and Nursing Activities Score (NAS). We assessed the association between values for CRAMS, PHI, and RTS and those for TISS-28 and NAS. Subsequently, we built a trauma score-emergency workload calculation model to quantitative workload estimation.

Significant correlations were observed for all pairs of trauma scoring models with emergency workload scoring models. TISS-28 score was significantly associated with PHI score and RTS; however, no significant correlation was observed between the TISS-28 score and CRAMS score.

CRAMS, PHI, and RTS were consistent in evaluating the injury condition of wounded individuals; TISS-28 and NAS scores were consistent in evaluating the required treatment workload. Dynamic changes in emergency workload in unit time were closely associated with wounded patient visits.

The aim of this study was to evaluate the effectiveness of training programs in improving the knowledge about disaster management among Accredited Social Health Activists (ASHAs) in Mysuru, India.

A quasi-experimental study was conducted among 40 ASHAs of 3 Primary Health Centers in Mysuru district. A 3-h disaster management training and workshop followed by a mock-drill was organized in each center. Knowledge about disaster preparedness and management was assessed before and 1 mo after the intervention using a questionnaire by interview method. The data obtained were entered into an MS Excel spreadsheet and analyzed using licensed SPSS 22 software.

The mean score obtained by the ASHAs in pretraining assessment was 37.2 ± 10.4. Improvement was evident in the knowledge and preparedness of ASHAs 1 mo after the training, which showed a mean score of 90.14 ± 5.05. This change in score was statistically significant with a P-value < 0.001 on performing a paired t-test.

Training programs with mock drills and hands-on activities are effective in improving the knowledge of frontline health workers about disaster management. We recommend such training to be organized in all public health facilities.

Since the beginning of the coronavirus disease (COVID-19) pandemic, several frontline workers have expressed their concerns about reduced emergency department (ED) utilization. We aimed to examine the changes in ED utilization during the early phase of the COVID-19 pandemic, in a country with a well-developed primary care system.

A retrospective analysis of ED utilization was performed in 3 Dutch hospitals during a 60-day period, starting on February 15, 2020. The identical period in 2019 was used as a reference. ED visits were labeled as COVID-related (defined as COVID-19 suspected) or non-COVID-related. Admission rates were compared using chi-square tests, and the reduction in ED visits was assessed descriptively.

During the study period, daily ED volume was 18% lower compared to that of 2019. ED utilization further declined (-29%) during lockdown. Combined admission rates were higher in 2020 compared to those in 2019 (P < 0.001), and they were higher for COVID-19 versus non-COVID-19 ED visits (P < 0.001).

ED utilization was markedly reduced during the local rise of COVID-19 in a region with a well-developed primary care system and relatively low ED self-referral rates. Although it cannot directly be concluded from the findings of our study, this observation likely reflects a complex interaction between pure lockdown effects and viral fear, which warrants further research.

We study the effect of the coronavirus disease 2019 (COVID-19) in India and model the epidemic to guide those involved in formulating policy and building health-care capacity.

This effect is studied using the Susceptible-Exposed-Infected-Recovered (SEIR) compartmental model. We estimate the infection rate using a least square method with Poisson noise and calculate the reproduction number.

The infection rate is estimated to be 0.270 and the reproduction number to be 2.70. The approximate peak of the epidemic will be August 9, 2020. A 25% drop in infection rate will delay the peak by 11 d for a 1-mo intervention period. The total infected individuals in India will be 9% of the total population.

The predictions are sensitive to changes in the behavior of people and their practice of social distancing.

Evaluate the relevance of the coronavirus disease 2019 (COVID-19) positive case detection policy or model implemented by the Ministry of Public Health (MPH) of Ecuador and to compare it with the experiences of other countries.

Data contained the daily reports publicized by the MPH. The formulations were carried out under the Conditioned Probability modality applying Bayes’ Theorem. All the COVID-19 tests applied in relation to the confirmed cases per million inhabitants were considered to obtain their level of positivity, and compared with the experience of Iceland and South Korea.

The probability of detecting positive cases of COVID-19 in Ecuador was higher than Iceland and South Korea, because the diagnostic tests were aimed at symptomatic patients, without identifying asymptomatic or mild symptomatic, who play an important role in the transmission of the disease. In addition, many symptomatic patients were examined but will remain undiagnosed due to the unavailability of tests and the low quality of many of them.

The daily reports on the behavior of the COVID-19 issued by the Ecuadorian government do not adequately represent the growth in the number of those infected each day, nor the actual behavior of the epidemic, affecting possible control measures.

Following stay-at-home (SAH) orders issued for coronavirus disease (COVID-19), state-level economic concerns increased and many let these orders expire. As a method to measure public preparedness, we sought to explore the association between public interest in preventive measures and the easing of SAH orders – specifically the increases in COVID-19 cases and fatalities after the orders expired.

Search volume was collected from Google Trends for “hand sanitizer,” “social distancing,” “COVID testing,” and “contact tracing” for each state. Bivariate correlations were computed to analyze associations between public interest in preventive measures, changes in confirmed COVID-19 cases after SAH expirations, COVID-19 case-fatality rates, and by-state presidential voting percentages.

A higher interest in preventive measures was associated with lower rates of confirmed cases after SAH orders had expired (r = −0.33), higher state-wide deaths per capita (r = 0.42), and case-fatality rates (r = 0.60). Moderate to strong negative correlations were found between states’ percentage of voters supporting the Republican nominee in 2016 and proportion of queries for average preventive measures (r = −0.77).

Our investigation shows that increased public interest in COVID-19 prevention was associated with longer SAH orders and less COVID-19 cases after the SAH orders’ expiration; however, it was also associated with higher case-fatality rates.

Qualitative fit testing is a popular method of ensuring the fit of sealing face masks such as N95 and FFP3 masks. Increased demand due to the coronavirus disease 2019 (COVID-19) pandemic has led to shortages in testing equipment and has forced many institutions to abandon fit testing. Three key materials are required for qualitative fit testing: the test solution, nebulizer, and testing hood. Accessible alternatives to the testing solution have been studied. This exploratory qualitative study evaluates alternatives to the nebulizer and hoods for performing qualitative fit testing.

Four devices were trialed to replace the test kit nebulizer. Two enclosures were tested for their ability to replace the test hood. Three researchers evaluated promising replacements under multiple mask fit conditions to assess functionality and accuracy.

The aroma diffuser and smaller enclosures allowed participants to perform qualitative fit tests quickly and with high accuracy.

Aroma diffusers show significant promise in their ability to allow individuals to quickly, easily, and inexpensively perform qualitative fit testing. Our findings indicate that aroma diffusers and homemade testing hoods may allow for qualitative fit testing when conventional apparatus is unavailable. Additional research is needed to evaluate the safety and reliability of these devices.

To date, we have only limited evidence of the determinants of earthquake inpatient mortality-related factors. This study is among the first to explore related factors of inpatient deaths using data from multiple hospitals and multiple earthquakes.

We included and retrospectively analyzed data on 32,976 earthquake inpatients in the West China Earthquake Patients Database. Of these, we analyzed the records of 284 patients who died during hospitalization. We collected 12 dichotomous variables with reference to previous reports: patients’ age (both ≤ 15 years and ≥ 65 years), gender, prehospital treatment, intensive care unit (ICU) admission, the presence of severe traumatic brain injury (TBI), trunk injury, severe poly-trauma, crush syndrome, multiple-system organ failure (MSOF), infection, and cardiac/respiratory disease. We performed multivariate logistic regression analysis to explore independent related factors of mortality.

Ultimately, we identified severe TBI, MSOF, old age (≥ 65 years), ICU admission, crush syndrome, and cardiac/respiratory disease as independent mortality-related factors. Severe TBI was the greatest risk factor of inpatient death (ods ratio [OR], 31.913, 95% confidence interval [CI], 20.484-49.720), followed by MSOF (OR 30.905, 95% CI, 21.733-43.947).

To reduce earthquake inpatient mortalities, the related factors analyzed in this study should be prioritized in future inpatient earthquake response strategies.

This study aimed at identifying the needs for the health workforce in 16 public health laboratories in the Serbian capital by assessing the workforce stock, workload activities, activity standards, and workload pressure.

A review of laboratory records and regulations, interviews with key respondents, and observing work processes provided data for the World Health Organization method for determining staffing needs based on workload indicators (Workload Indicators of Staffing Need, WISN).

A total of 99 laboratory workers spend almost 70% of their available working time in undertaking core activities. Core activities per sample can take from 0.25 to 180 min. Laboratory workers are under moderate or high workload pressure (the WISN ratio from 0.86 to 0.50). The WISN difference indicates a shortage of 22.22% of laboratory analysts and 20.63% of laboratory technicians. To balance the staffing to workload, these laboratories need an additional 8 FTE analysts and 13 FTE technicians. They could also consider selectively reducing workload pressure by automating some of the additional activities while maintaining the competence of laboratory workers and opportunities for professional development.

Staffing policy should account for work processes, activity standards, and workload pressure to determine necessary staffing to meet the need for laboratory services in the local context.

Systematic monitoring of exanthema is largely absent from public health surveillance despite emerging diseases and threats of bioterrorism. Michigan Child Care Related Infections Surveillance Program (MCRISP) is the first online program in child care centers to report pediatric exanthema.

MCRISP aggregated daily counts of children sick, absent, or reported ill by parents. We extracted all MCRISP exanthema cases from October 1, 2014 through June 30, 2019. Cases were assessed with descriptive statistics and counts were used to construct epidemic curves.

360 exanthema cases were reported from 12,233 illnesses over 4.5 seasons. Children ages 13-35 months had the highest rash occurrence (45%, n = 162), followed by 36-59 months (41.7%, n = 150), 0-12 months (12.5%, n = 45), and kindergarten (0.8%, n = 3). Centers reported rashes of hand-foot-mouth disease (50%, n = 180), nonspecific rash without fever (15.3%, n = 55), hives (8.1%, n = 29), fever with nonspecific rash (6.9%, n = 25), roseola (3.3%, n = 12), scabies (2.5%, n = 9), scarlet fever (2.5%, n = 9), impetigo (2.2%, n = 8), abscess (1.95, n = 7), viral exanthema without fever (1.7%, n = 6), varicella (1.7%, n = 6), pinworms (0.8%, n = 3), molluscum (0.6%, n = 2), cellulitis (0.6%, n = 2), ringworm (0.6%, n = 2), and shingles (0.2%, n = 1).

Child care surveillance networks have the potential to act as sentinel public health tools for surveillance of pediatric exanthema outbreaks.

Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients.

This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests.

A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 s; P = 0.01), automated external defibrillator (AED) placement (+9.5 s; P = 0.01), intraosseous line insertion (+7 s; P < 0.0001), tourniquet (+8.5 s; P < 0.0001), intramuscular injection (+21-23 s, P < 0.0001), and pulse oximetry (+4 s; P < 0.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use.

PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.

The aim of this study was to explore the application of the flipped classroom approach in the training of Mass Casualty Triage (MCT) to medical undergraduate students.

In this study, 103 fourth-year medical students were randomly divided into a Flipped Classroom (FC) group (n = 51) and a Traditional Lecture-based Classroom (TLC) group (n = 52). A post-class quiz, simulated field triage (SFT) and feedback questionnaires were performed to assess both groups of students for their learning of the course.

In the post-quiz, the median (IQR) scores achieved by students from the FC and TLC groups were 42(5) and 39(5.5), respectively. Significant differences were found between the two groups. In the SFT, overall triage accuracy was 67.06% for FC, and 64.23% for TLC students. Over-triage and under-triage errors occurred in 18.43% and 14.50% of the FC group, respectively. The TLC group had a similar pattern of 20.77% over-triage and 15.0% under-triage errors. No significant differences were found regarding overall triage accuracy or triage errors between the two groups.

The FC approach could enhance course grades reflected in the post-quiz and improve students’ satisfaction with the class. However, there was no significant difference of competency between the two groups demonstrated in the SFT exercise.