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Introduction:The elderly have the highest rates of morbidity/mortality in a disaster and are therefore the most vulnerable. 50% of deaths in Hurricane Katrina were ≥75 years old. In the California wildfires, most deaths were people in their 70s and 80s living in areas with unreliable communication services (without cell phone service, etc.), and were uninformed of the disaster or unable and/or unwilling to evacuate. Issues include social isolation and limited technology skills (may not receive messages).Methods:A review of the literature and after action reports from multiple disasters.Results:Augmented services are needed for persons with decreased mobility (impaired access to transportation and shelters); impaired senses; dependence on devices/technology, comorbidities requiring medications/equipment/oxygen, special feedings, sanitary/hygiene needs increased susceptibility to environmental extremes (heat, cold), inability to do ADLs (need for caregivers), increased susceptibility and increased morbidity/mortality with infections, illnesses, trauma; exacerbation of underlying conditions/illnesses when in crowded transportation vehicles and shelters. Additional stress may precipitate or exacerbate coping skills especially in those with dementia, delirium, or mental health illnesses.Discussion:Recommendations include the following: 1.Communications: messages in various forms: closed captioning, TTY deaf phones, use of family, friends, neighbors, officials for notification in addition to mass communication notices, house-to-house notification.2.Medical: Medical/Special Needs Shelters to provide medical care (dialysis, etc.), cache of common medications (diabetic and BP medications) and devices (BP monitoring, glucometers), oxygen, wound care supplies, potable and non-potable water, special diets/formulas, feeding tubes, catheter care, diapers and other hygiene supplies.3.Independence: Health care professionals to assist with medical and psychiatric needs. Caregivers to assist with ADLs.4. Supervision: Those with dementia, delirium, mental health conditions may need supervision.5. Transportation: Need for ambulances, wheelchair vans, specially equipped buses/vans in addition to “usual” school buses/vans with access to water, food, and sanitation if traveling long distances.

Introduction:Individuals may not receive messages via usual sources. Social media such as Facebook, LinkedIn, Twitter and social networking groups have been useful in the notification, information dissemination, safe notices, and reunification.Methods:A survey of the literature and of social media sites to determine what possibilities of notification, information exchange, marked safe, and reunification information that can be helpful in disasters.Results:Social media is useful during all phases of a disaster: pre-disaster notification, information dissemination during disasters, and safe notices/reunification post-disasterDiscussion:Social media is internet-based and requires a device that needs power. There is widespread internet access to various forms of social media, such as email, various broadcast sources, and social networking sites. Social media may provide pre-disaster warnings (weather alert app, reverse 911), evacuation/sheltering information, blocked routes, open gas stations, stores with supplies, hotels/motels with rooms, and shelter locations. Social networking groups were full of messages informing others they could shelter someone fleeing the California wildfires and recent hurricanes. Volunteers can be alerted and responses collected via social media groups. Social media may reach individuals earlier than official announcements, although sometimes accuracy may be in question. Rumor and malignant information source as well as inaccurate information are possible and may need to be managed. Separation is common during disasters. Knowing if their loved ones are safe and well, then reunifying is critical, especially for the vulnerable: children/infants, elderly, and disabled. Reunification systems need safeguards for vulnerable individuals who may be exploited or abused during disasters. In previous disasters (Hurricanes Maria, Mark, and others; California wildfires), when usual communication was nonfunctional due to downed power lines or damaged/destroyed substations; social media was deluged with individuals giving names and identifying information for family and others and asking whether anyone has seen or heard from them.

Introduction:Those residing in supervised facilities including nursing homes, mental health facilities, group homes, and penal institutions for health, legal, or security reasons present unique challenges in a disaster.Methods:A review of the literature and after action reports on supervised and institutionalized populations in disasters.Results:Recommendations for supervised, institutionalized populations in a disaster include: (1.) preplanned agreements for specialized transportation if needed; (2.) reciprocal agreements between similar facilities (nursing home with another nursing home, prison with other prison, dialysis centers, etc.) for resource sharing; (3.) arrangements for sharing and emergency privileging of personnel in institutions that are not their primary workplace; (4.) just-in-time training for appropriate volunteers; and (5.) accommodations for family members if personnel are to be available during a disaster.Individuals in some institutions need a personalized disaster plan with pertinent data: next of kin with contact information, medical records, care providers and care plan to accompany a mobilized individual. Long-term care and housing may be needed if the institution is nonfunctional. Dealing with medical and behavioral issues is secondary to the disaster. Chronic issues must be considered as well.Discussion: Caring for specialized, institutional individuals is complex and difficult. Comprehensive pre-disaster planning can mitigate the effects of the disaster.

Introduction:Between 2000 to 2017, there were over 150 hospital evacuations in the United States. Data received from approximately 35 states were primarily concentrated in California, Florida, and Texas. This analysis will provide disaster planners and administrators statistics on hazards that cause disruptions to hospital facilities.Aim:The aim of this study is to investigate US hospital evacuations by compiling the data into external, internal, and man-made disasters thus creating a risk assessment for disaster planning.Methods:Hospital reports were retrieved from LexisNexis, Google, and PubMed databases and categorized according to evacuees, duration, location, and type. These incidents were grouped into three classifications: external, internal, and man-made. Both partial and full evacuations were included in the study design.Results:There were a total of 154 reported evacuations in the United States. 110 (71%) were due to external threats, followed by 24 (16%) man-made threats, and 20 (13%) internal threats. Assessing the external causes, 60 (55%) were attributed to hurricanes, 21 (19%) to wildfires, and 8 (7%) to storms. From the internal threats, 8 (40%) were attributed to hospital fires and 4 (20%) chemical fumes. From the man-made threats, 6 (40%) were attributed to bomb threats and 4 (27%) gunmen. From the 20 total reported durations of evacuations, 9 (45%) lasted between 2 to 11:59 hours, 6 (30%) lasted over 24 hours, and 5 (25%) lasted up to 1:59 hours.Discussion:Over 70% of hospital evacuations in the US were due to natural disasters. Compared to 1971-1999, there was an increase in internal and man-made threats. Exact statistics on evacuees, durations, injuries, and mortality rates were unascertainable due to a lack of reporting. It is critical to implement a national registry to report specifics on incidences of evacuations to further assist with disaster and infrastructure planning.

Introduction:There are an estimated 15,600 nursing homes with a total of 1.4 million residents in the United States. The number of residents will continue to increase due to the aging population, and the associated morbidities will make it difficult to evacuate them safely.Aim:This study is the first of its kind to provide an analysis of the number of nursing home deaths caused by external and internal events following evacuations.Methods:Information from the databases Lexis Nexis and PubMed were compiled and limited to news articles from 1995-2017. The gathered information included the reason for evacuation, injuries, deaths, and locations within the United States.Results:From 1995 to 2017, there was a total of 51 evacuations and 141 deaths in nursing homes. 27 (53%) evacuations were due to external events which resulted in a combined 121 (86%) deaths, and 24 (47%) evacuations were due to internal events which resulted in a combined 20 (14%) deaths. Hurricanes were responsible for the majority of deaths during evacuations, followed by fires and floods. The number of evacuations and deaths increased the greatest between 2005 to 2008.Discussion:External events have the greatest impact on loss of life. Internal disasters are about equal in the number of incidents, however, external events have a much greater mortality rate. Exact numbers on injuries, morbidity, and mortality are difficult to ascertain, but it appears to be related to natural disasters. In view of the increasing likelihood of natural disasters related to global warming, a drastic improvement of standard evacuation procedures of long-term nursing homes is critical to decreasing mortality of nursing home residents. There also needs to be a nationally standardized method of reporting evacuations in order to better analyze data on nursing homes.

Hypothesis: Do paramedics influence the outcome of out of hospital cardiac arrests in a rural setting?Methods: Retrospective analysis of cardio-respiratory arrests of ALS-EMS system in rural Southeastern Alaska for 9 years. There were two patient groups treated by EMT-III or paramedics. EMT-III vs. paramedics differ in training/experience but not technical skills. Statistical analyses were done by chi square.Results: Thirty-seven patients (52%) were treated by paramedics, thirty-four (48%) by EMT-III. Demographics/CPR variables for the groups were not significantly different. Comparing paramedics vs. EMT-III: successful ET placement (87% vs. 62%, p p p = 0.01), ICU admission 38% (14/37) vs. 15% (5/34) (p = 0.03), hospital discharge 20% (7/35) vs. 9% (3/34) (p = NS). There was no correlation between successful ET placement or IV insertion and outcome.