We investigated the accuracy of initial critical care triage in blast-injured versus non-blast-injured trauma patients, focusing on those inappropriately triaged to the intensive care unit (ICU) for brief (<16 h) stays.

We conducted a retrospective review of the Israel National Trauma Registry, applying a predetermined definition of need for initial ICU admission.

A total of 883 blast-injured and 112 185 non-blast-injured patients were categorized according to their need for ICU admission. Of these admissions, 5.7% in the blast setting and 8.4% in the non-blast setting were considered unnecessary. The sensitivity, specificity, and positive and negative likelihood ratios for the triage officers' decisions in assigning patients to the ICU were 95.5%, 98.8%, 77.2, and 0.05, respectively, in the blast setting, and 91.2%, 99.5%, 200.5, and 0.09, respectively, in the non-blast setting.

Triage officers do a better job sending to the ICU only those patients who require initial intensive care in the non-blast setting, though this is obscured by a much greater overall need for ICU-level care in the blast setting. Implementing triage protocols in the blast setting may help reduce the number of patients sent initially to the ICU for brief periods, thus increasing the availability of this resource. (Disaster Med Public Health Preparedness. 2014;0:1–7)

The use of spontaneous volunteers (SV) is common after a disaster, but their limited training and experience can create a danger for the SVs and nongovernmental voluntary organizations (NVOs). We assessed the experience of NVOs with SVs during disasters, how they were integrated into the agency's infrastructure, their perceived value to previous responses, and liability issues associated with their use.

Of the 51 National Voluntary Organizations Active in Disasters organizations that were contacted for surveys, 24 (47%) agreed to participate.

Of the 24 participating organizations, 19 (72%) had encountered SVs during a response, most (79%) used them regularly, and 68% believed that SVs were usually useful. SVs were always credentialed by 2 organizations, and sometimes by 6 (31%). One organization always performed background checks; 53% provided just-in-time training for SVs; 26% conducted evaluations of SV performance; and 21% provided health or workers compensation benefits. Two organizations reported an SV death; 42% reported injuries; 32% accepted legal liability for the actions of SVs; and 16% were sued because of actions by SVs.

The use of SVs is widespread, but NVOs are not necessarily structured to incorporate them effectively. More structured efforts to integrate SVs are critical to safe and effective disaster response. (Disaster Med Public Health Preparedness. 2014;8:65-69)

The Incident Command System (ICS) is an adaptable construct designed to streamline response efforts to a disaster or other incident. We aimed to examine the methods used to teach the ICS at US veterinary schools and to explore alternative and novel methods for instruction of this material.

A total of 29 US accredited veterinary schools (as of February 2012) were surveyed, and 18 of the 29 schools responded.

The ICS and related topics were taught by both classroom methods and online instruction by most of the surveyed schools. Several of the schools used readily available Federal Emergency Management Agency and US Department of Agriculture resources to aid in instruction. Most schools used one course to teach the ICS, and some schools also used unique methods such as field exercises, drills, side-by-side training with disaster response teams, elective courses, extracurricular clubs, and externships to reinforce the ICS and related topics. Some of the surveyed institutions also utilized fourth-year clinical rotations and field deployments during actual disasters as a component of their ICS and emergency response curriculum.

The ICS is being taught at some form at a significant number of US veterinary schools. Additional research is needed to evaluate the efficacy of the teaching methods of the ICS in US veterinary schools. (Disaster Med Public Health Preparedness. 2014;8:505-510)

The emergency preparedness of residents of North Carolina and Montana were compared.

General preparedness was evaluated using responses to 4 questions related to a household's 3-day supply of water, 3-day supply of nonperishable food, a working battery-operated radio, and a working battery-operated flashlight. Each positive answer was awarded 1 point to create an emergency preparedness score that ranged from 0 (minimum) to 4 (maximum). Results were assessed statistically.

The average emergency preparedness score did not differ between the 2 states (P = .513). One factor influencing higher preparedness in both states was being male. Other influencing factors in North Carolina were older age, being a race/ethnicity other than white, having an annual income of $35 000 or more, having children in the household, better (excellent/very good/good) self-reported health, and not being disabled. In contrast, other factors influencing higher emergency preparedness in Montana were having a college degree and being married or partnered.

A divergence was found in factors influencing the likelihood of being prepared. These factors were likely a result of different sociodemographic and geographic characteristics between the 2 states. (Disaster Med Public Health Preparedness. 2014;0:1-4)

To examine their implementation, we analyzed World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) guidelines from 2005 to 2008 for risk communication during an emerging infectious disease outbreak, WHO and CDC reports on implementing the guidelines worldwide after the 2009 H1N1 pandemic; and a case study of a member state.

A qualitative study compared WHO and CDC guidelines from 2005 to 2008 with WHO and CDC reports from 2009 to 2011, documenting their implementation during the H1N1 outbreak and assessed how these guidelines were implemented, based on the reports and Israeli stakeholders (n=70).

Eight risk communication subthemes were identified: trust, empowerment, uncertainty, communicating the vaccine, inclusion, identification of subpopulations and at-risk groups, segmentation, and 2-way communication. The reports and case study disclosed a gap between international guidelines and their local-level implementation. The guidelines were mostly top-down communications, with little consideration for individual member-state implementation. The WHO and CDC recommendations were not always based on formative evaluation studies, which undermined their validity.

In formulating effective communication strategies, the first step is to define the goal of a vaccination program. We recommend implementing conceptual elements from the most current theoretical literature when planning communication strategies and increasing organizational involvement in implementing guidelines in future health crises. (Disaster Med Public Health Preparedness. 2014;0:1–12)

The Great East Japan Earthquake and tsunami affected approximately 53 000 people in the city of Ishinomaki, Miyagi Prefecture. Approximately 30 000 people were relocated to temporary/rental housing. The remainder re-inhabited tsunami-affected houses, and their conditions were not known. As social isolation could affect physical and psychological health, we investigated the risk of social isolation among the survivors who returned to their homes.

The surveyors went door-to-door to the tsunami-affected houses and interviewed each household between October 2011 and March 2012. The participants’ risk of social isolation was assessed using 3 factors: whether they have (1) friends to talk with about their problems, (2) close neighbors, and (3) social/family interactions. We analyzed the groups at risk of social isolation and identified the related factors.

The elderly (older than age 65 years) were more likely to have close neighbors and social/family interactions, as compared with younger persons. Persons living alone were less likely to have social/family interactions. Non-elderly men who were living alone were the highest proportion of people without social/family interactions.

Our findings suggested that men, particularly those younger than age 65 years and living alone, were at high risk of social isolation and may need attention. (Disaster Med Public Health Preparedness. 2014;0:1-8)

Working within a series of partnerships among an academic health center, local health departments (LHDs), and faith-based organizations (FBOs), we validated companion interventions to address community mental health planning and response challenges in public health emergency preparedness.

We implemented the project within the framework of an enhanced logic model and employed a multi-cohort, pre-test/post-test design to assess the outcomes of 1-day workshops in psychological first aid (PFA) and guided preparedness planning (GPP). The workshops were delivered to urban and rural communities in eastern and midwestern regions of the United States. Intervention effectiveness was based on changes in relevant knowledge, skills, and attitudes (KSAs) and on several behavioral indexes.

Significant improvements were observed in self-reported and objectively measured KSAs across all cohorts. Additionally, GPP teams proved capable of producing quality drafts of basic community disaster plans in 1 day, and PFA trainees confirmed upon follow-up that their training proved useful in real-world trauma contexts. We documented examples of policy and practice changes at the levels of local and state health departments.

Given appropriate guidance, LHDs and FBOs can implement an effective and potentially scalable model for promoting disaster mental health preparedness and community resilience, with implications for positive translational impact.(Disaster Med Public Health Preparedness. 2014;8:511-526)

Emergency and core ambulance personnel work under all environmental conditions, including severe weather condtions. We evaluated emergency medical personnel in Çanakkale, Turkey, for their degree of preparedness.

A descriptive study was conducted in Çanakkale, Turkey, within 112 emergency service units and their 17 district stations. Surveys were developed to measure the level of preparedness for serious winter conditions that individual workers made for themselves, their homes, and their cars.

Of the 167 survey participants, the mean age was 29.8 ± 7.9 years; 52.7% were women; more than half (54.75%) were emergency medical technicians; and 53.3% were married. Only 10.4% of those who heated their homes with natural gas had carbon monoxide detectors. Scores relating to household and individual preparation for severe winter conditions increased by participants’ age (P < .003), being married (P < .000) and working in the city center (P < .021); and for men whose cars were equipped with tow ropes, extra clothing, and snow tires (P < .05). Absenteeism was higher for central-city personnel than district workers because they were less prepared for harsh winter conditions (P = .016).

Many of the surveyed emergency health personel demonstrated insufficient preparations for serious winter conditions. To increase the safety and efficiency of emergency medical personnel, educational training programs should be rountinely conducted. (Disaster Med Public Health Preparedness. 2014;0:1-4)

The participants in a 2011 drive-through influenza vaccination clinic were described.

The descriptive, cross-sectional study used a pen-and-paper survey administered during a drive-through vaccination program. A total of 1114 surveys were collected that included demographic information and responses to 3 clinic usage questions; responses were in English or Spanish. The responses were stratified by language and age group, and zip codes reported by the participants were mapped.

The majority of the participants were women (57%) aged 41 to 64 years old (53%). The participation by people younger than 18 and older than 65 years was relatively low. When compared by language, the surveys completed in Spanish showed a significantly different proportion of age group participation than those completed in English. Many participants (23%) indicated that they likely would not have received a vaccine elsewhere if the clinic were not available. A map of the zip codes showed that the clinic served people from the city and surrounding communities and counties.

The operators of vaccine clinics can use these findings to improve outreach to populations of concern, and encourage multiple venues, both traditional and nontraditional, to maximize immunization coverage in their community (Disaster Med Public Health Preparedness. 2014;0:1-4).

Disaster health workers currently have no common standard based on a shared set of competencies, learning objectives, and performance metrics with which to develop courses or training materials relevant to their learning audience. We examined how existing competency sets correlate within the 2012 pyramidal learning framework of competency sets in disaster medicine and public health criteria and describe how this exercise can guide curriculum developers.

We independently categorized 35 disaster health-related competency sets according to the 4 levels and criteria of the pyramidal learning framework of competency sets in disaster medicine and public health.

Using the hierarchical learning framework of competency sets in disaster medicine and public health criteria as guidance, we classified with consistency only 10 of the 35 competency sets.

The proposed series of minor modifications to the framework should allow for consistent classification of competency sets. Improved education and training of all health professionals is a necessary step to ensuring that health system responders are appropriately and adequately primed for their role in disasters. Revising the organizing framework should assist disaster health educators in selecting competencies appropriate to their learning audience and identify gaps in current education and training. (Disaster Med Public Health Preparedness. 2014;8:70-78)

The reauthorization of the Pandemic and All-Hazards Preparedness Act in 2013 incorporated the dental profession and dental professionals into the federal legislation governing public health response to pandemics and all-hazard situations. Work is now necessary to expand the processes needed to incorporate and train oral health care professionals into pandemic and all-hazard response events.

A just-in-time (JIT) training exercise and immunization drill using an ex vivo porcine model system was conducted to demonstrate the rapidity to which dental professionals can respond to a pandemic influenza scenario. Medical history documentation, vaccination procedures, and patient throughput and error rates of 15 dental responders were evaluated by trained nursing staff and emergency response personnel.

The average throughput (22.33/hr) and medical error rates (7 of 335; 2.08%) of the dental responders were similar to those found in analogous influenza mass vaccination clinics previously conducted using certified public health nurses.

The dental responder immunization drill validated the capacity and capability of dental professionals to function as a valuable immunization resource. The ex vivo porcine model system used for JIT training can serve as a simple and inexpensive training tool to update pandemic responders’ immunization techniques and procedures supporting inoculation protocols.

The success of the Medical Reserve Corps (MRC) is dependent on the ability of volunteers to respond in a timely and effective manner. This study aimed to assess the current status of MRC volunteer training and to examine the association between MRC characteristics and provision of training.

The data for this study were drawn from the 2013 Network Profile Survey of the MRC, which was administered to active MRC unit leaders or designated alternates of 962 units across the country in April to May of 2013.

Over 80% of MRCs had a training plan. Ninety-one percent of MRCs offered one or more training courses to volunteers, and 73% indicated requirements for mandatory training. Approximately 84% of MRC units collaborated with other organizations to conduct trainings. Units with more volunteers (>150) were 3 times as likely to have a plan for volunteer training as were those with fewer volunteers (≤50). Compared to units with a full-time leader, those with leaders who were volunteers were only 0.57 times as likely to have a training plan.

An overwhelming majority of MRC units provide critical training to their volunteers prior to an emergency deployment. To further strengthen the overall MRC capacities, it is important for MRC units to have a training plan tailored to their community needs and features, make full use of available training resources, and collaborate with partner organizations. (Disaster Med Public Health Preparedness. 2014;8:527-532)

This report aimed to examine the literature regarding evidence about community-based interventions that use the concept of resilience to increase positive health outcomes after disaster.

A search was conducted of databases; gray literature, public health journals, and available key journals focused on disaster, emergency, and trauma from inception to December 2013. Excluded were non-English publications, only about children or adolescents, or a commentary or theoretical discussion on resilience.

From a total of 1880 records, excluding duplicates, 8 studies were found. Exclusions included participants younger than age 18 years (n=74), non-English (n=40), nonempirical (n=265), not referring to disaster (n=188), not a public health intervention (n=319), and not related to an intervention targeting resilience (n=890).

This systematic review highlighted a gap in the evidence relating to interventions targeting the resilience of adults who have experienced a disaster. The results were mixed in relation to information provision but promising for strategies that promote social interactions or develop community competence. Future studies could explore the ability of interventions to build the intrinsic capacity of a system, community, or society at risk of a disaster to adapt and survive. (Disaster Med Public Health Preparedness. 2014;0:1-9)

To assess the health of community residents following a coal fly ash spill at the Tennessee Valley Authority Kingston Fossil Plant in Harriman, Tennessee, on December 22, 2008.

A uniform health assessment was developed by epidemiologists at Oak Ridge Associated Universities and medical toxicologists at Vanderbilt University Medical Center. Residents who believed that their health may have been affected by the coal fly ash spill were invited to participate in the medical screening program.

Among the 214 individuals who participated in the screening program, the most commonly reported symptoms were related to upper airway irritation. No evidence of heavy metal toxicity was found.

This is the first report, to our knowledge, regarding the comprehensive health evaluation of a community after a coal fly ash spill. Because this evaluation was voluntary, the majority of residents screened represented those with a high percentage of symptoms and concerns about the potential for toxic exposure. Based on known toxicity of the constituents present in the coal fly ash, health complaints did not appear to be related to the fly ash. This screening model could be used to assess immediate or baseline toxicity concerns after other disasters. (Disaster Med Public Health Preparedness. 2014;0:1–8)

Hospitals are expected to function as a safe environment during disasters, but many become unusable because of nonstructural damage. This study compares the nonstructural safety of hospitals to disasters in Tehran and Stockholm.

Hospital safety in Tehran and Stockholm was assessed between September 24, 2012, and April 5, 2013, with use of the nonstructural module of the hospital safety index from the World Health Organization. Hospital safety was categorized as safe, at risk, or inadequate.

All 4 hospitals in Stockholm were classified as safe, while 2 hospitals in Tehran were at risk and 3 were safe. The mean nonstructural safety index was 90% ± 2.4 SD for the hospitals in Stockholm and 64% ± 17.4 SD for those in Tehran (P = .014).

The level of hospital safety, with respect to disasters, was not related to local vulnerability. Future studies on hospital safety should assess other factors such as legal and financial issues. (Disaster Med Public Health Preparedness. 2014;0:1-6)