This article sought to explore how older people maintained their health and managed chronic conditions during the 2019-2020 Black Summer bushfires, floods, and COVID-19 pandemic in Australia. This knowledge is important in the context of intersecting public health and environmental hazards.

Qualitative, semi-structured interviews were undertaken with 19 community-dwelling older people living in South Eastern New South Wales, a region significantly impacted by the successive disasters.

Three themes summarized participants’ experiences. Participants described disruption to daily activities and social networks, delayed treatment and disruption to health services, and the exacerbation of health issues and emergence of new health challenges as challenges to managing health and self-care. Strategies for staying healthy were described as drawing on connections and relationships and maintaining a sense of normalcy. Finally, the compounding nature of disasters highlighted the impact of successive events.

Understanding older people’s experiences of self-care during disasters is critical for developing interventions that are better targeted to their needs. This study highlights the importance of social connectedness, habit, and routine in health and well-being. Results should inform policymaking and guide interventions in health care for older people.

The objective of this study was to assess recovery of Aransas County, Texas households 2 years after Category 4 Hurricane Harvey made landfall.

A 2-stage cluster sampling method used to conduct a Community Assessment for Public Health Emergency Response (CASPER) on May 3 - 4 and May 18 - 19, 2019. A household-based survey was administered through face-to-face interviews, selected through systematic random sampling using weighted analysis of the county population. Field teams collected 175 surveys (83.3% completion rate).

Approximately 57% households experienced repairable damage, 23% had destroyed homes, and 19% had minimal damage. 38% stated having ‘no need,’ 18% needed financial assistance, 16% needed household repairs, and over 8% had behavioral health needs. 17% experiencing a behavioral health concern were seeking services. Of the 35% of households who did not seek services, 14% felt there was no need, and 4% were not aware of the resources available.

Households reported high levels of preparedness, but gaps remain in evacuation intention and behavioral health care access. CASPERs are effective in assessing long-term recovery of communities impacted by major disasters.

“Determine which clients to recommend for discharge in a disaster situation” is a Registered Nurse Activity Statement on the National Council Licensing Exam test plan. The activity statement raised the nursing education research question: could senior student nurses transfer their learning to a novel circumstance, with a high degree of risk, making decisions using patient assessments and determining resource needs? A study with a descriptive quantitative approach was designed with 2 aims. The first was to describe students’ transfer of learning for basic disaster and medical-surgical knowledge and make recommendations for patient dispositions. The second aim was to describe students’ attitudes about their transfer of learning during the tabletop exercise.

A researcher-designed disaster-scenario tabletop exercise and 3 instruments with subject-matter-expert feedback captured participants’ decisions. Eligible senior student nurses volunteered to participate in the replicated study that was extended to 2 universities. Participant decisions and attitude responses were statistically analyzed.

Descriptive and difficulty index statistics described students’ transfer of learning for basic disaster and medical-surgical topics, patient disposition recommendations, and attitudes. The cut-score for optimal transfer of learning was difficulty index (DI) ≤ .49.

Students had positive attitudes and transferred learning to most decisions. Decision DIs ≤ .49 were remediated.

Public health and emergency management agencies play a critical role in addressing the needs of vulnerable populations in preparation for and in response to emergencies. Identifying and leveraging community assets is a way to address such needs. This study focuses on the development of a process and tools to engage community leaders in sharing their knowledge about their community characteristics and assets useful for emergency planning.

We conducted interviews with community leaders across five study sites with the goal of understanding what type of local knowledge community leaders are able to share in regard to emergency preparedness. Based on the interview results we developed and tested a mobile application as a mobile friendly directory of community assets.

We identified two main types of local knowledge about community assets for emergency preparedness: communication-based and trust-based local knowledge. We created an application to facilitate the sharing of such knowledge. Community leaders were able to share local knowledge across four areas: communication-based assets, trust-based assets, spatial-based assets and personal-preparedness assets.

Community leaders’ engagement in preparedness efforts is important to identify community assets that can be leveraged to address the needs of the most vulnerable segments of a community.

How people behave in a crisis depends on their understanding and evaluation of risk and vulnerability. Therefore, this study was conducted to investigate the Iranians’ risk perception of coronavirus disease (COVID-19).

An online survey was applied, which resulted in the collection of information on demographics, the 5 dimensions of risk perception (cognitive, political, social, cultural, and emotional), and trust in the government among the Iranian users of social networks. Data were analyzed by descriptive and analytical tests of SPSS (IBM Corp, Armonk, NY) software, and confirmatory factor analysis of Amos software.

A total of 364 persons from 20 provinces completed the questionnaire during February 25 to March 2, 2020. More than 80% of the participants believed that negligence and lack of close supervision of the authorities have led to the spread of COVID-19. The mean (SD) risk perception was 58.77 (± 10.11), indicating the medium level of risk perception of people. The second-order confirmatory factor analysis also indicated that cultural dimension had the highest positive correlation (0.96), emotional dimension had the highest negative correlation (-0.65), and social dimension had the least correlation with the risk perception model (0.08).

Iranians’ risk perception of the COVID-19 outbreak is not optimal, and it seems necessary to improve it.

Drive-through clinics (DTCs) are a novel type of point of dispensing where participants drive to a designated location and receive prophylaxis while remaining inside their vehicle. The objective of this review was to identify effective practices and recommendations for implementing DTCs for mass prophylaxis dispensing during emergency events.

A systematic review was conducted for articles covering DTCs published between 1990 and 2019. Inclusion criteria were peer-reviewed, written in English, and addressed DTCs sufficiently. Effective practices and recommendations identified in the literature were presented by theme.

A total of 13 articles met inclusion criteria. The themes identified were (1) optimal DTC design and planning via decision support systems and decision support tools; (2) clinic layouts, locations, and design aspects; (3) staffing, training, and DTC communication; (4) throughput time; (5) community outreach methods; (6) DTC equipment; (7) infection prevention and personal protective equipment; and (8) adverse events prevention and traffic management.

DTCs are an essential component of emergency preparedness and must be optimally designed and implemented to successfully dispense mass prophylaxis to a community within 48 hours. The effective practices and recommendations presented can be used for the development, implementation, and improvement of DTCs for their target populations.

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)

The key to resilience after disasters is the provision of coordinated care and resource distribution to the affected community. Past research indicates that the general public lacks an understanding regarding agencies’ roles and responsibilities during disaster response.

This study’s purpose was to explore the general public’s beliefs regarding agencies or organizations’ responsibilities related to resource management during disasters. In addition, the public’s attitudes towards the management and use of community disaster assistance centers were explored.

Qualitative interviews were conducted with members of the general public. Interviews were audio-recorded and transcribed verbatim. Content analysis was used to analyze the data and identify themes that describe the public’s expectations of disaster response agencies and the use of community disaster assistance centers.

A total of 28 interviews were conducted. Half of the participants (n=14) were black, 57% (n=16) were female, and the mean age was 49 years. The general public has developed trust and distrust toward response organizations and governmental agencies based on past experiences during disasters. The public wishes to have local agencies to help lead disaster response, but expects a collaboration between all response organizations, including the government. The managing agency overseeing community disaster assistance centers was not perceived as important, but the proximity of these centers to community members was considered critical.

The general public prefers that local agencies and leaders manage disaster response, and they expect collaboration among response agencies. Community assistance centers need to be located close to those in need, and be managed by agencies trusted by the general public. (Disaster Med Public Health Preparedness. 2018;12:446–449)

Public health preparedness is an ever-evolving area of medicine with the purpose of helping the masses quickly and efficiently. The drive-through clinic (DTC) model allows the distribution of supplies or services while participants remain in their cars. Influenza vaccination is the most common form of DTC and has been utilized successfully in metropolitan areas.

We hypothesized that combining influenza vaccinations and child passenger seat fittings in a DTC format would be both feasible and desired by the community. Each driver was verbally surveyed at each DTC station. The project was a combination of patient survey and observation.

In the inaugural 6-hour DTC session, 86 cars were served and contained 161 children, of which 28 also participated in child passenger seat fittings. The median total clinic time regardless of services rendered was 9.0 minutes (interquartile range [IQR]: 6.0, 14.0 minutes). For those who received only an influenza vaccine, the median total time was 7.5 minutes (IQR: 6.0, 10.0 minutes). For those who received both services, the median total time was 27 minutes (IQR: 22.3, 33.5 minutes) with an average of 1.75 child passenger seat fittings per automobile.

This was a pilot study involving 2 different services using the DTC model and the first of its kind in the literature. The DTC was successful in executing both services without sacrificing speed, convenience, or patient satisfaction. Additional studies are needed to further evaluate the efficacy of the multiple-service DTC model. (Disaster Med Public Health Preparedness. 2017;11:647–651)

Health agencies working with the homebound play a vital role in bolstering a community’s resiliency by improving the preparedness of this vulnerable population. Nevertheless, this role is one for which agencies lack training and resources, which leaves many homebound at heightened risk. This study examined the utility of an evidence-based Disaster Preparedness Toolkit in Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) programs.

We conducted an online survey of all VHA HBPC program managers (N=77/146; 53% response rate).

Respondents with fewer years with the HBPC program rated the toolkit as being more helpful (P<0.05). Of those who implemented their program’s disaster protocol most frequently, two-thirds strongly agreed that the toolkit was relevant. Conversely, of those who implemented their disaster protocols very infrequently or never, 23% strongly agreed that the topics covered in the toolkit were relevant to their work (P<0.05).

This toolkit helps support programs as they fulfill their preparedness requirements, especially practitioners who are new to their position in HBPC. Programs that implement disaster protocols infrequently may require additional efforts to increase understanding of the toolkit’s utility. Engaging all members of the team with their diverse clinical expertise could strengthen a patient’s personal preparedness plan. (Disaster Med Public Health Preparedness. 2017;11:56–63)

Local health departments (LHDs) have little guidance for operationalizing community resilience (CR). We explored how community coalitions responded to 4 CR levers (education, engagement, partnerships, and community self-sufficiency) during the first planning year of the Los Angeles County Community Disaster Resilience (LACCDR) Project.

Sixteen communities were selected and randomly assigned to the experimental CR group or the control preparedness group. Eight CR coalitions met monthly to plan CR-building activities or to receive CR training from a public health nurse. Trained observers documented the coalitions’ understanding and application of CR at each meeting. Qualitative content analysis was used to analyze structured observation reports around the 4 levers.

Analysis of 41 reports suggested that coalitions underwent a process of learning about and applying CR concepts in the planning year. Groups resonated with ideas of education, community self-sufficiency, and engagement, but increasing partnerships was challenging.

LHDs can support coalitions by anticipating the time necessary to understand CR and by facilitating engagement. Understanding the issues that emerge in the early phases of planning and implementing CR-building activities is critical. LHDs can use the experience of the LACCDR Project’s planning year as a guide to navigate challenges and issues that emerge as they operationalize the CR model. (Disaster Med Public Health Preparedness. 2016;10:812–821)