Research connects health outcomes to hazard exposures but often neglects the nature of the exposure or repeated events.

We undertook a cross-sectional study (N = 1,094) from a representative sample in the Houston Metropolitan Statistical Area (HMSA). Respondents were recruited using Qualtrics panels, targeting individuals reflecting the population of the HMSA. Physical composite scores (PCS) were calculated using the SF-12v2.

Among the hazards (hurricanes, flooding, tornadoes, chemical spills, industrial fires), only chemical spills showed a dose-response: physical health scores declined significantly with repeated exposures. This decline persisted after multiple linear regression. Covariates including sex, race, age, education, and chemical exposure affected PCS, but chemical spill exposure remained the most significant, negatively affecting PCS even after adjusting for other factors (coef =–2.24, 95% CI, –3.33 to –1.15).

Grasping the effects of hazards, especially repeated ones, can guide emergency management in mitigation, recovery, and preparedness efforts.

This manuscript summarizes the global incidence, exposures, mortality, and morbidity associated with extreme weather event (EWE) disasters over the past 50 years (1969-2018).

A historical database (1969-2018) was created from the Emergency Events Database (EM-DAT) to include all disasters caused by seven EWE hazards (ie, cyclones, droughts, floods, heatwaves, landslides, cold weather, and storms). The annual incidence of EWE hazards and rates of exposure, morbidity, and mortality were calculated. Regression analysis and analysis of variance (ANOVA) calculations were performed to evaluate the association between the exposure rate and the hazard incidence rate, as well as the association between morbidity and mortality incidence rates and rates of human exposure and annual EWE incidence.

From 1969-2018, 10,009 EWE disasters caused 2,037,415 deaths and 3,998,466 cases of disease. A reported 7,350,276,440 persons required immediate assistance. Floods and storms were the most common. Most (89%) of EWE-related disaster mortality was caused by storms, droughts, and floods. Nearly all (96%) of EWE-related disaster morbidity was caused by cold weather, floods, and storms. Regression analysis revealed strong evidence (R2 = 0.88) that the annual incidence of EWE disasters is increasing world-wide, and ANOVA calculations identified an association between human exposure rates and hazard incidence (P value = .01). No significant trends were noted for rates of exposure, morbidity, or mortality.

The annual incidence of EWEs appears to be increasing. The incidence of EWEs also appears to be associated with rates of human exposure. However, there is insufficient evidence of an associated increase in health risk or human exposures to EWEs over time.

This study examined disaster preparedness, risk perception, and their association in rural hospitals in the United States. The focus of disaster preparedness largely has been centered on urban areas, in part because of the perception that more concentrated areas have an increased risk of a disastrous event. Therefore, it was hypothesized that risk perception may be a contributing factor for adequate preparedness in rural areas. This research was a component of a larger study of rural hospital preparedness. The objective of this study was to describe the perceived risk of disaster events and the status of disaster preparedness in rural hospitals. It was hypothesized that there is a positive association between risk perception and preparedness.

Secondary data analysis was conducted using the National Study of Rural Hospitals (2006–2007) from Johns Hopkins University. The study, based on a regionally stratified, random sample of rural hospitals, consisted of a mailed questionnaire and a follow-up telephone interview with each hospital's Chief Executive Officer (n = 134). A model of disaster preparedness was utilized to examine seven elements of preparedness. Risk perception was examined through seven perceived risk threats.

The results indicated that rural hospitals were moderately prepared, overall,(78% prepared on average), with higher preparedness in education/training (89%) and isolation/decontamination (91%); moderate preparedness in administration/planning (80%), communication/notification (83%), staffing/support (66%), and supplies/pharmaceuticals/laboratory support (70%); and lower preparedness in surge capacity (64%).

The respondents reported greater perceived risk from disasters due to natural hazards (79% reported moderate to high risk) and vehicular accidents (77%) than from humanmade disasters (23%). Results obtained from logistic regression models indicated that there was no statistically significant difference in the odds of a hospital being prepared overall when comparing high versus low risk perception (OR = 0.61; 95% CI = 0.26–1.44). Positive associations were identified only between higher perceived risk overall and the subcategory of education/training preparedness (OR = 1.24; 95% CI = 1.05–1.27).

Rural hospitals reported being moderately prepared in the event of a disaster with a low perception of risk for human-made disasters. Further research should be conducted to identify predictors of preparedness in rural hospitals in order to optimize readiness for potential disaster events.

This Supplement is a Report of the Conference convened by the Regional Office for South East Asia (SEARO) of the World Health Organization (WHO). The Conference was a follow-up to the WHO Conference of May 2005 in Phuket, Thailand on the Earthquake and Tsunami of 26 December 2004. The invitational meeting brought together representatives of 11 countries impacted by the events. The goal of the Conference was to produce a plan of action that meets the specific needs of the countries and ensure that the countries of the Region will be better equipped to cope with any future event.

The objectives of the Conference were to: (1) identify gaps in the health needs of the affected and vulnerable populations for preparedness, responses, recovery, and rehabilitation; (2) determine the next steps in addressing these gaps; and (3) develop benchmarks and a corresponding framework for action that must be achieved to solidify the capacities and capabilities of the health sector to meet emergencies.

Presentations of background papers, panel discussions, and Working Groups were used. Based, in part, on the materials presented, the Working Groups drafted benchmarks that could mark the progress in achieving the overall goal and proposed strategies that could be used to reach the benchmarks. Representatives of the participating countries summarized the current status of their respective countries relative to each of the defined benchmarks.

The benchmarks relate to: (1) legal framework for preparedness and response; (2) national disaster plan for preparedness and response; (3) budget; (4) rules of engagement for external actors; (5) community plan based on risk identification and vulnerability assessment; (6)community-based capacities; (7) local capacity for provision of essential services and supplies; (8) awareness and advocacy programs; (9) identification of hazards, risks, and vulnerabilities; (10) education and training; (11) “safe” health facilities; and (12) surveillance and early warning systems.

There exists a wide range in the levels of preparedness at all levels in the affected countries particularly at the community level. The country representatives agreed that community-level preparedness, legal frameworks, local and national disaster plans, surveillance and early warning systems, and advocacy and awareness programs demand more attention.

The strategies and mechanisms that will facilitate achievement of the benchmarks were grouped into seven categories: (1) monitoring, evaluation, surveillance, and assessments; (2) education and training (human resource development); (3) information and communications; (4) legislation, policies, and authority; (5) funding; (6) planning and preparedness; and (7) coordination and control. Any or all of the strategies suggested could be implemented by the countries in the Region.

The Conference delivered an important set of benchmarks and strategies that, when implemented, will facilitate the countries and the communities within them reaching better levels of preparedness and response to future events. Attaining the benchmarks will decrease the number of lives lost and minimize the pain and suffering associated with such events.

Epidemiological research about disasters is difficult to perform. Most often, it must be completed retrospectively, since data collection may not be feasible or possible during the disaster.Now, there is a recognized need for a standard method to assess the severity of a disaster.

The aim of this paper is to assess the severity of the disasters that occurred in Italy during the 20th century, using a Disaster Severity Scale (DSS). Another goal is to find a standard method for the classification of previous disasters, test the feasibility and reliability of the use of the Disaster Severity Scale, and improvedisaster management and planning.

Data were obtained from formal reports of the Civil Defence Unit (Italy) and were used to calculate the Disaster Severity Scale score. Disasters were classified into major and minor disasters, according tothe numbers of deaths and severity of the damage. The number of deaths was compared with the obtained Disaster Severity Scale score. A seasonal trend for different types of events was obtained to assess if there is a relationship between the type of event and the time of the year in which it occurred, as related to the weather conditions existing at that time.

There were enough data to calculate a Disaster Severity Scale score for 26 major events that caused death and economic damage, and occurred in Italy between 18 March 1944 and 11 November 1999, and for 82 minor events, that occurred between October 1982 and December 1999. There were some significant peaks varying from different types of events during particular seasons, but the cause for those with the highest incidence is not clear. Events related to natural hazards were the only type of event that reached the highest Disaster Severity Scale when considering the number of deaths, while no events associated with man-made hazards had a Disaster Severity Scale score >8.

The Disaster Severity Scale score could be a reliable index for the assessment of events related to either natural or man-made disasters. Use of the Disaster Severity Scale allows researchers to classify previous hazards by scoring each disaster's severity. Further studies in other countries could be useful to further validate the Disaster Severity Scale.

To investigate the relative distribution of hazards causing hospital evacuations, thereby to provide rudimentary risk information for hospital disaster planning.

Cases of hospital evacuations were retrieved from newspaper and publication databases and classified according to hazard type, proximate and original cause, duration, and casualties. Both partial and full evacuations were included. The total number of evacuation incidents for all hazards were compared to the total number of hospital incidents for the one hazard, fire, for which national data is available.

There were 275 reported evacuation incidents from 1971–1999, with an annual average of 21 in the 1990s, the period for which databases were more reliable. The most, 33, were recorded in 1994, the year of the Northridge Earthquake. Of all incidents, 63 (23%) were attributable primarily to internal fire, followed by internal hazardous materials (HazMat) events (18%), hurricane (14%), human threat (13%), earthquake (9%), external fire (6%), flood (6%), utility failure (5%), and external HazMat (4%).

More than 50% of the hospital evacuations occurred because of hazards originating in the hospital facility itself or from human intruders. While natural disasters were not the preponderant causes of evacuations, they caused severe problems when multiple hospitals in the same urban area were incapacitated simultaneously. Clearly, as hospitals are vulnerable to many hazards, mitigation investments should be assessed not in terms of single-hazard risk-cost-benefit analysis, but in terms of capacity to mitigate multiple hazards. In view of the many qualifications and limitations of the dataset used here, but value of such data for disaster planning, hospitals should be asked to submit standardized incident reports to permit national data gathering on major disruptions.