On April 27, 2011, the state of Alabama encountered a horrific day of tornados that left a trail of damage throughout the state. The city of Tuscaloosa was devastated by an EF-4 that resulted in many victims and casualties. Druid City Hospital in Tuscaloosa had a massive inflow of victims with both mild and major injuries. When disasters such as this occur, nurses must respond with efficiency and effectiveness to help as many victims as possible. However, little is known about the psychological effects of disasters on nurses and how these impact nurses both personally and professionally. Because resilience can directly impact how a nurse responds to a situation, this article aimed to examine the resilience levels of nurses working during the disaster.

This study was part of a larger study examining the needs of nurses both before and after disasters. Ten nurses were interviewed and completed a 10-item survey on resilience, the Connor-Davidson Resilience Scale (CD-RISC). The full range of scores on this scale is from 0 to 40, with higher scores reflecting greater resilience.

In this survey of 10 nurses, the scores ranged from 33 to 40, with a mean score of 36.7.

The nurses who were interviewed and completed the survey possessed a high level of resilience. More research should be done on the causes of increased resilience in nurses after disasters. (Disaster Med Public Health Preparedness. 2015;9:601–604)

The legal environment may improve response willingness among local health department (LHD) workers. We examined whether 3 hypothetical legal protections influence LHD workers’ self-reported response willingness for 4 emergency scenarios and whether specific demographic factors are associated with LHD workers’ response willingness given these legal protections.

Our 2011–2012 survey included questions on demographics and about attitudes and beliefs regarding LHD workers’ willingness to respond to 4 emergency scenarios given specific legal protections (i.e., ensuring priority health care for workers’ families, granting workers access to mental health services, and guaranteeing access to personal protective equipment). Data were collected from 1238 LHD workers in 3 states.

Across scenarios, between 60% and 83% of LHD workers agreed that they would be more willing to respond given the presence of 1 of the 3 hypothetical legal protections. Among the 3 legal protections, a guarantee of personal protective equipment elicited the greatest agreement with improved response willingness.

Specific legal protections augment a majority of LHD workers’ response willingness. Policymakers must, however, balance improved response willingness with other considerations, such as the ethical implications of prioritizing responders over the general public. (Disaster Med Public Health Preparedness. 2015;9:98–102)

To demonstrate the application of economics to health care preparedness by estimating the financial return on investment in a substate regional emergency response team and to develop a financial model aimed at sustaining community-level disaster readiness.

Economic evaluation methods were applied to the experience of a regional Pennsylvania response capability. A cost-benefit analysis was performed by using information on funding of the response team and 17 real-world events the team responded to between 2008 and 2013. By use of the results of the cost-benefit analysis as well as information on the response team’s catchment area, a risk-based insurance-like membership model was built.

The cost-benefit analysis showed a positive return after 6 years of investment in the regional emergency response team. Financial modeling allowed for the calculation of premiums for 2 types of providers within the emergency response team’s catchment area: hospitals and long-term care facilities.

The analysis indicated that preparedness activities have a positive return on their investment in this substate region. By applying economic principles, communities can estimate their return on investment to make better business decisions in an effort to increase the sustainability of emergency preparedness programs at the regional level. (Disaster Med Public Health Preparedness. 2015;9:344–348)

From January 29 through February 5, 2013, a school district outside metropolitan Denver, Colorado, was closed because of absenteeism related to influenza-like illness (ILI) among students and staff. We evaluated the consequences and acceptability of the closure among affected households.

We conducted a household survey regarding parent or guardian employment and income interruptions, alternative child care arrangements, interruption of noneducational school services, ILI symptoms, student re-congregation, and communication preferences during the closure.

Of the 35 (31%) of 113 households surveyed, the majority (28 [80%]) reported that the closure was not challenging. Seven (20%) households reported challenges: 5 (14%) reported that 1 or more adults missed work, 3 (9%) reported lost pay, and 1 (3%) reported challenges because of missed subsidized school meals. The majority (22 [63%]) of households reported that a hypothetical 1-month closure would not represent a problem; 6 of 8 households that did anticipate challenges reported that all adults worked outside the home. The majority (58%) of students visited at least 1 outside venue during the closure.

A brief school closure did not pose a major problem for the majority of the affected households surveyed. School and public health officials should consider the needs of families in which all adults work outside the home when creating school closure contingency plans. (Disaster Med Public Health Preparedness. 2015;9:4-8)

Radiological terror presents a real threat, but little is known about how low-income, urban African Americans may respond to such threats. The aim of this study was to understand the unique challenges of this group and to explore their knowledge of what a “dirty bomb” is, their intended behaviors should one occur, and their barriers to complying with “shelter in place” recommendations.

Thirty-seven 18-65-year-olds who were users of community centers in disadvantaged areas participated in 3 focus groups in Philadelphia. Results were analyzed by using the Krueger method of analyzing narrative text.

The responses highlighted little knowledge or concern about a dirty bomb. Lack of trust in local authorities was expressed, with participants indicating that they did not feel their needs were addressed. While shelter in place was understood, most said they would still check on family or talk with others to get the “whole truth” because the most trusted information sources were neighbors and community leaders.

Our results indicate that a risk communication intervention for urban minorities may support desirable behaviors in the event of a dirty bomb, but successful communication will require establishing a local leader as a spokesperson to convince people of the importance of sheltering in place.(Disaster Med Public Health Preparedness. 2015;0:1-10)

We launched a health promotion program called the Hamarassen (“let’s get together”) Farm, which provided farming opportunities for the victims of the Great East Japan Earthquake who resided in temporary housing. The aim of this study was to evaluate the effects of this program on physical and mental health in terms of bone mineral density (BMD) and a sense of purpose in life.

Among 39 female participants in whom BMD was evaluated, there were 12 Hamarassen participants, 8 self-farming control subjects, and 19 non-farming control subjects. BMD was measured by calcaneal quantitative ultrasound immediately after the project launch and 5 months later. A sense of purpose in life prior to and 2 months after the project’s commencement was measured in 21 additional Hamarassen participants by use of the K-I Scale. Interviews were also conducted to qualitatively evaluate the effects of the Hamarassen program.

The mean BMD T-score improved by 0.43 in the Hamarassen group, by 0.33 in the self-farming group, and by 0.06 in the controls (p=0.02). Among the 21 Hamarassen participants in whom mental health was evaluated, the average score for a sense of purpose in life improved from 20.5 to 24.9 (p=0.001).

The Hamarassen Farm provided disaster victims with opportunities for social participation, interpersonal interaction, and physical exercise; such opportunities may improve physical and psychosocial well-being. (Disaster Med Public Health Preparedness. 2015;9:103-110)