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The COVID-19 pandemic illuminated shortcomings in the ability of community hospitals in the United States to respond to crises of this nature. This has led to questions about the effectiveness of community hospital disaster preparedness. A study of hospital preparedness in New York State in 2017 revealed a number of barriers to preparedness. Among the most significant are economic barriers, given that disaster preparedness is not a reimbursable cost like patient care. The economic challenges have been exacerbated by a decline in federal disaster preparedness funding in recent years. Reflecting on previous writings, the author provides several options for overcoming these barriers to ensure hospitals are better prepared for future disasters.

Objective:We conducted a systematic review to determine the prevalence and characteristics of earthquake-associated head injuries for better disaster preparedness and management.Methods:We searched for all publications related to head injuries and earthquakes from 1985 to 2018 in MEDLINE and other major databases. A search was conducted using “earthquakes,” “wounds and injuries,” and “cranio-cerebral trauma” as a medical subject headings.Results:Included in the analysis were 34 articles. With regard to the commonly occurring injuries, earthquake-related head injury ranks third among patients with earthquake-related injuries. The most common trauma is lower extremity (36.2%) followed by upper extremity (19.9%), head (16.6%), spine (13.1%), chest (11.3%), and abdomen (3.8%). The most common earthquake-related head injury was laceration or contusion (59.1%), while epidural hematoma was the most common among inpatients with intracranial hemorrhage (9.5%) followed by intracerebral hematoma (7.0%), and subdural hematoma (6.8%). Mortality rate was 5.6%.Conclusion:Head injuries were found to be a commonly occurring trauma along with extremity injuries. This knowledge is important for determining the demands for neurosurgery and for adequately managing patients, especially in resource-limited conditions.

Objectives: To evaluate the Ministry of Health (MoH) hospitals preparedness for potential disasters and crisis events using the World Health Organization (WHO) hospital emergency response checklist. Methods: A cross-sectional study was conducted at MoH hospitals in Al-Madina, Saudi Arabia using the WHO hospital emergency response checklist. The overall level of hospital preparedness was categorized as unacceptable if the rating is between 0-64, insufficient if it is between 65-129 and effective preparedness if the score is between 130-184. The study conducted in 3 phases. First phase, the preintervention assessment was conducted from August 23 to 27, 2017. Second phase, intervention strategies were implemented between 2018 and 2019 to enhance the hospitals preparedness for any potential disaster situation. Third phase, the postintervention assessment was conducted from September 5 to 7, 2019, using with the same checklist. Results: The preparedness score of key components at the participating hospitals showed an “insufficient” level of preparedness. The mean preparedness score of the participating hospitals was 81.5±11.39 (range: 65-91), which is lower than the recommended WHO cut-off level of effective preparedness. The preparedness score of the post-recovery component was very low 01±1.15 compared to the WHO range (0-18). Conclusion: A total of 4 hospitals participated in the study. The participated hospitals showed insufficient levels of preparedness for potential disasters and crisis events.

Emergency Medical Services (EMS) personnel frequently encounter animals in situations ranging from injured law enforcement canines (LEK9s) to pets with smoke inhalation injury. In recent years, several US states have enacted laws that legally allow EMS personnel to provide basic emergency care to certain animals. Currently, nine states allow some type of emergency medical treatment and/or ambulance transport of animals by EMS, and five states limit liability for vehicle damage resulting from rescuing animals trapped inside. Despite this expanding body of legislation encouraging EMS to assist animals, EMS personnel are not typically trained in the safe handling or medical treatment of animals. Interaction with veterinary patients can pose serious injury and infectious disease risks to untrained EMS personnel. Furthermore, relationships with veterinarians must be built and treatment and transport protocols must be developed for EMS agencies to appropriately care for these animals. This report serves as an initial framework from the veterinary perspective for EMS consideration regarding current legislation, safety concerns, transport protocols, and common life-saving treatments in the prehospital emergency care of animals. Increased collaboration between EMS personnel and veterinary professionals provides an opportunity to develop quality training programs for EMS and to improve disaster preparedness of the whole community.

Objective:Emergency medicine being a young specialty in India, we aimed to assess the level of disaster preparedness and planning strategies among various academic emergency departments (EDs) across India during the coronavirus disease 2019 (COVID-19) pandemic.Methods:A cross-sectional multicentric survey was developed and disseminated online to various academic EDs in India and followed up over a period of 8 wk. All results were analyzed using descriptive statistics.Results:Twenty-eight academic emergency medicine departments responded to the study. Compared with pre-COVID period, COVID-19 pandemic has led to 90% of centers developing separate triage system with dedicated care areas for COVID suspected/infected in 78.6% centers with nearly 70% using separate transportation pathways. Strategizing and executing the Institutional COVID-19 treatment protocol in 80% institutes were done by emergency physicians. Training exercises for airway management and personal protective equipment (PPE) use were seen in 93% and 80% centers, respectively. Marked variation in recommended PPE use was observed across EDs in India.Conclusions:Our study highlights the high variance in the level of preparedness response among various EDs across India during the pandemic. Preparedness for different EDs across India needs to be individually assessed and planned according to the needs and resources available.

The earthquake that occurred during school hours requires the school community to have a high level of preparedness so as not to fall victim and loss a lot. This activity aims to measure the level of preparedness against the threat of earthquake disasters and provide earthquake disaster preparedness training to the Muhammadiyah Banyuraden Elementary School community. The method used was a survey using a questionnaire, analysis of survey results based on the UNSESCO framework, namely knowledge of earthquake disasters, policies and guidelines, emergency response plans, and resource mobilization. The analysis showed that the community preparedness level of SD Muhammadiyah Banyuraden was at a moderate level with a total preparedness index of 55.8. The lowest preparedness index is in the policy and guideline parameters. The results of the survey and analysis carried out resulted in preparedness strengthening activities carried out to increase the preparedness index, namely the formation of disaster preparedness groups, compiling evacuation route maps, adapting earthquake simulations, training on first aid and evacuation, and simulating earthquake evacuation. The activities to strengthen preparedness have an impact on the preparedness index

Over the last 3 years at a large, midwestern, pediatric hospital, there have been near disaster events, a few of which required transfer or evacuation of patients. The responses from the inpatient units to these events have varied greatly and can be traced back to communication, knowledge, comfort level, and effectiveness of the charge nurses on the nursing units. A task force was formed to understand the variation in their disaster response procedures and to standardize disaster response procedures. Respondents included the bedside, clinical leadership, managers of patient services, emergency preparedness management, and senior leadership. This resulted in the creation of a tabletop simulation exercise for use by inpatient charge nurses within the institution. The results indicated that participants reported higher levels of self-reported knowledge, confidence, and effectiveness regarding the disaster preparedness on their units (p < 0.001). The program was effective, with feedback from participants indicating the need for more frequent and/or department specific education.

In this thesis, a questionnaire was conducted with fire service, administrative, and police officials, as well as academic and front-line medical institutions, participating in disaster preparedness drills in a local community. The questionnaire assessed the quality of disaster preparedness training that is still to be implemented in Korea. In addition, the appropriateness of each element of training was assessed with a suitable question, and the opinions of respondents were analyzed. Results indicated that respondents gave a relatively generous evaluation of their own fields or a relatively low evaluation of the group that was most active in training, etc. It was confirmed that differences in perception were determined by relative differences among the groups surveyed. In the future, detailed follow-up studies on items that revealed differences in perceptions should be used to improve the effectiveness and efficiency of disaster preparedness training.

Emergency departments (EDs) worldwide struggled to prepare for coronavirus disease 2019 (COVID-19) patient surge and to simultaneously preserve sufficient capacity for “regular” emergency care. While many hospitals used costly shelter facilities, it was decided to merge the acute medical unit (AMU) and the ED. The conjoined AMU-ED was segregated into a high-risk and a low-risk area to maintain continuity of emergency care. This strategy allowed for a feasible, swift, and dynamic expansion of ED capacity without the need for external tent facilities. This report details on the technical execution and discusses the pearls and potential pitfalls of this expansion strategy. Although ED preparedness for pandemics may be determined by local factors, such as hospital size, ED census, and primary health-care efficacy, the conjoined AMU-ED strategy may be a potential model for other EDs.

Purpose Despite the fact that hospitals are always at a high risk of disasters, the preparedness status in many of the Ethiopian hospitals is not well recognized. It is with this research gap in mind that this study motivated the authors to assess disaster preparedness level in selected hospitals of the western part of Ethiopia and their authorities' risk perceptions. Methods This was a facility-based study conducted by using mixed qualitative and quantitative research designs among selected hospitals of western Ethiopia. While disaster and emergency readiness was evaluated using a modified World Health Organization observation check list. The key informant interview method was used to assess the disaster risk perception of the hospitals' authorities in the study area. Results The overall level of emergency and disaster preparedness in the selected hospitals was weak with an average calculated preparedness score of 45.6%. The score of readiness in terms of disaster response and recovery planning was 33.3%. Moreover, we have not got a documented disaster plan in all of the hospitals and the hazard-specific response sub plans were also not consistently in place. Of prime concerns, this study has revealed that there was no patient evacuation plan in all of the selected hospitals. The human resource preparations of the hospitals were relatively better with an average readiness score of 60%. The study has found that no committee was responsible for emergency readiness at all of the sampled hospitals. The hospital authorities' disaster risk perception was found to vary according to the type of calamities and this was from moderate to high level. Conclusion This study concludes that although their authorities' risk perception of disasters was high, the selected hospitals were ill-prepared for the potential disaster strikes in this study area.

Background: On March 2020, because of the COVID-19 pandemic, the Swiss Federal Council mobilised conscript formations of the Swiss Armed Forces. This was the largest military mobilisation since the Second World War. Purpose: To assess the roles of the militia pharmacy officers deployed throughout the country to assist the healthcare system. Method: All missions performed by militia pharmacy officers were systematically collected and evaluated. They were also compared to the official duties of pharmacists in the Swiss Armed Forces. Results: Ten pharmacy officers were enlisted in two out of four hospital battalions deployed, as well as in the medical logistic battalion and in the staff of the logistic brigade that embedded them. Their missions were mainly planning, conduct and control of medical logistics, as well as hygiene and drug manufacturing activities. In the hospital battalions, they especially managed: 1) supply of medical material dedicated to mission-related training, civilian health facilities assistance and medical transportation; 2) establishment and application of hygiene procedures; 3) provision of conscripts’ own medication. In the medical logistic battalion, the support of both military and civilian pharmaceutical production facilities was the most important activity (e.g. disinfectants and anaesthetics manufacturing). Conclusion: Thanks to their civilian and military background, militia pharmacy officers have been quickly and effectively deployed throughout the country. The role of pharmacists within their respective battalions has emerged as especially crucial in the pandemic context and some of the performed missions were beyond their traditional duties. Their basic training has to be further developed accordingly.

Disaster medicine refers to situations in which the need to care for patients outweighs the available resources. It is imperative for anesthesiologists to be involved at a leadership level in mass casualty/disaster preparedness planning. Mass casualty disaster plans should be clear, concise, and easy to follow. Terror events and natural disasters can differ significantly in anesthesia preparedness. Resiliency is an important aspect of the recovery phase that decreases psychological damage in the aftermath of a mass casualty event.

Changes to community psychiatry during COVID-19 are unprecedented and without clear guidelines. Minimizing disruption, ensuring quality care to the already vulnerable people with serious mental illness is crucial. We describe and reflect our adaptations and innovations at one community psychiatry program, based on three key principles. In (i) Defining and maintaining essential services while limiting risk of contagion, we discuss such strategies and ways to assess risks, implement infection control, and other creative solutions. In (ii) Promoting health and mitigating physical and mental health impacts, we reflect on prioritizing vulnerable patients, dealing with loss of community resources, adapting group programs, and providing psychoeducation, among others. In (iii) Promoting staff resilience and wellness, we describe building on strength of the staff early, addressing staff morale and avoiding moral injury, and valuing responsive leadership. We also identify limitations and potential further improvements, mindful that COVID-19 and similar crises are likely recurring realities.

Introduction: In the last 10 years, Mount Bromo has erupted four times; 2004, 2010, 2015 and 2019. However, it is unique that people at Tengger are reluctant to evacuate even though Mount Bromo is erupting and releasing volcanic material such as stones and dust. Methods: This research is a quantitative study, using correlative analytic observational design and cross sectional approach with pourposife sample of 120 taken from online questionare results of bivariate analysis using gamma correlation test obtained the results of knowledge factors (p=0.005; r=0.27) attitude (p=0.000; r=0.45), means of infrastructure (p=0.000; r=0.58), and android application (p=0.000; r=0.59) for health preparedness. Results: Knowledge, attitude, infrastructure and android application factors can influence health preparedness in disaster risk reduction in Bromo area.Using the smartphone application as the Mount Bromo information facilities are one of an effort so that people and tourists can activate if an eruption occurs. There is important health preparedness about features made in the application such as distribution shelters, evacuation routes, health centres, photos, videos, and primary health care information. Conclusion: Assessment results to the application interface, the information conveyed, and the features offered showed that the application was very useful and gives a new perspective in conveying accurate information to the public and also tourists. The health preparedness community level is also quite good with the services provided by the Bromo alert application.

Natural disasters are devastating to not only our physical property but also to our health. There have been several studies over the last few decades that have correlated different types of natural disasters with acute myocardial infarctions (AMIs). Since the early 1930's singular meteorological events have been reported to have some association and effect on cardiovascular (CV) mortality and morbidity. Multiple natural disasters regardless of location have repeatedly reported a significant increase in the incidence of acute coronary syndromes (ACS). Each event was associated with similar mechanisms, which increase the overall CV mortality. The most prominent of those being neurohormonal activation, total scarcity of supplies and access to health care, poverty, stress, increased incidence of smoking and drug abuse. Increased incidence of associated infections added to the burden of ACS. We know natural disasters are inevitable; however, disaster preparedness is surely a reliable way to help curb their devastating effects on human life. In this manuscript, the authors present many forms of natural disasters and their association with acute myocardial infarction (AMI).

According to the World Risk Report in 2018, Bangladesh has been identified as the most vulnerable country in the world. Among the 64 districts of this country, 19 districts are known as coastal districts 36.8 million people live in high-risk areas. The main objective of this paper is to investigate the reasons and factors why many residents do not comply with evacuation orders to cyclone shelters in an emergency period. Based on survey data collected from the survivors this paper finds that prior to the landfall of cyclone Komen in 2015 the majority of the respondents in Kutubdia Upazila had received cyclone warning either from Cyclone Preparedness Program volunteers or the radio, but only 61% of respondents in this village responded to the warning by seeking protection in the nearby shelter. The major identified reasons for 39% of respondent’s non-compliance with evacuation orders are the long distance of a cyclone shelter from home, an absence of the head of the family, gender-related concerns, not enough space in the shelter, the poor road network and no space for livestock in the shelter. It is also found that people did not start evacuation until observing the symptom of risk. To improve cyclone preparedness and response to evacuation orders from residents, an educational campaign by Government and Non-Government Organizations (NGOs) is needed in coastal zones to improve the use of public cyclone shelters. Finally, to reduce risk Government should take the initiative for infrastructural development in the coastal areas of Bangladesh.

Objective:The aim of this study was to evaluate the readiness of a tertiary medical cityʼs response to a disaster by assessing the hospital resources and knowledge, attitudes, practices, and familiarity of health care providers toward disaster and emergency preparedness.Methods:All KFMC (King Fahad Medical City) staff with > 1 year of clinical experience were eligible to participate in a cross-sectional study. Participants responded to the Emergency Preparedness Information Questionnaire (EPIQ), knowledge and practice questionnaires, and a disaster planning attitude checklist. Data about resources were collected using the hospital disaster preparedness self-assessment tool.Results:The overall mean knowledge score for disaster and emergency preparedness was 4.4 ± 1.1, and the mean overall familiarity score was 3.43 ± 0.97. Most participants knew that disaster drills (90.2%) and training (74.6%) are ongoing. Sixty-six (21.0%) agreed that KFMC is unlikely to experience a disaster. The highest and lowest EPIQ familiarity scores were for decontamination (83.0%) and accessing critical resources and reporting (64.3%), respectively. Most participants (99.4%) have access to work computers; however, only 53.0% used the Internet to access information on bioterrorism and/or emergency preparedness. The hospital is ready to respond in case of a disaster according to the used tool.Conclusions:The participants’ levels of knowledge, practices, and overall familiarity toward emergency and disaster preparedness were satisfactory; however, participant attitudes and familiarity with where and how to access critical resources in the event of an emergency or disaster situations require reinforcement.

NICU patients are disproportionately affected by any disaster due to their vulnerability and highly specialized care needs that require a multitude of resources. Research in disaster preparedness and its effect on NICU patients is limited. From March to May 2018, NICUs across California participated in a survey designed to assess their preparedness for a disaster. Of the 84 responding units, 99% were urban, 73% were nonprofit, and 65% were community NICUs. As for NICU participation in hospital training exercises for disaster preparedness, 10% did not participate in annual drills, 44% did once a year, 36% did twice a year, and 10% did more than two times per year. We showed that many NICUs had redundant systems in place and plans for various disasters; however, there is not consistent participation by NICUs in hospital training exercises for disaster preparedness.

Members of an emergency department (ED) staff need to be prepared for mass casualty incidents (MCIs) at all times. Didactic sessions, drills, and functional exercises have shown to be effective, but it is challenging to find time and resources for appropriate training. We conducted brief, task-specific drills (deemed “disaster huddles”) in a pediatric ED (PED) to examine if such an approach could be an alternative or supplement to traditional MCI training paradigms. Over the course of the study, we observed an improving trend in the overall score for administrative disaster preparedness. Disaster huddles may be an effective way to improve administrative disaster preparedness in the PED. Low-effort, low-time commitment education could be an attractive way for further disaster preparedness efforts. Further studies are indicated to show a potential impact on lasting behavior and patient outcomes.

Objective:This team created a manual to train clinics in low- and middle-income countries (LMICs) to effectively respond to disasters. This study is a follow-up to a prior study evaluating disaster response. The team returned to previously trained clinics to evaluate retention and performance in a disaster simulation.Background:Local clinics are the first stop for patients when disaster strikes LMICs. They are often under-resourced and under-prepared to respond to patient needs. Further effort is required to prepare these crucial institutions to respond effectively using the Incident Command System (ICS) framework.Methods:Two clinics in the North East Region of Haiti were trained through a disaster manual created to help clinics in LMICs respond effectively to disasters. This study measured the clinic staff’s response to a disaster drill using the ICS and compared the results to prior responses.Results:Using the prior study’s evaluation scale, clinics were evaluated on their ability to set up an ICS. During the mock disaster, staff was evaluated on a three-point scale in 13 different metrics, grading their ability to mitigate, prepare, respond, and recover in a disaster. By this scale, both clinics were effective (36/39; 92%) in responding to a disaster.Conclusion:The clinics retained much prior training, and after repeat training, the clinics improved their disaster response. Future study will evaluate the clinics’ ability to integrate disaster response with country-wide health resources to enable an effective outcome for patients.

The 2017 Atlantic hurricane season was especially memorable for 3 major hurricanes—Harvey, Irma, and Maria—that devastated population centers across Texas, Florida, and Puerto Rico, respectively. Each storm had unique hazard properties that posed distinctive challenges for persons living with type 1 diabetes (T1D). Diabetes care specialists and educators took on leadership roles for coordinating care and establishing insulin supply lifelines for people with T1D living in the hardest-hit neighborhoods affected by these extreme storms. Strategies and resources were customized for each population. Diabetes specialists strategized to provide mutual support and shared insulins and supplies across sites.

Objective:The current study was conducted to assess disaster preparedness of hospitals in the Eastern region of Saudi Arabia.Methods:A descriptive cross-sectional study of all hospitals in the Eastern Region of KSA was conducted between July 2017 and July 2018. The included hospitals were selected using convenience sampling. The questionnaire was distributed together with an official letter providing information about the aim and objectives of the study as well as ethical issues guiding their participation in the exercise.Results:All the included hospitals had a disaster plan that was completely accessible by all staff members. About 70% of the included hospitals established an educational program on disaster preparedness once per year. Assessment of hospital disaster preparedness was conducted using disaster drills in 62 (n= 98%) of the hospitals. However, only 9.5% of the hospitals had post-disaster recovery assistance programs like counseling and support services.Conclusion:Most hospitals involved in this study had sufficient resources for disaster management; however, the overall effectiveness of hospitals’ disaster preparedness was slight to moderate. Some recommendations to improve hospitals’ disaster preparedness should be proposed, including improved staff training and testing, better communications and safety procedures, and adoption of a holistic approach for disaster management.

Objective: To assess the level of neonatal intensive care unit (NICU) disaster preparedness among pediatric residents. Methods: A mixed-methods study including qualitative interviews and quantitative surveys was used. Interviews guided survey development. Surveys were distributed to residents who rotated through Children’s National NICU. Questions assessed residents’ background in disaster preparedness, disaster protocol knowledge, NICU preparedness, roles during surge and evacuation, and views on training and education. Results: Survey response was 62.5% (n = 80) with 51.3% of invited residents completing it. Pediatric residents (PGY-2 and PGY-3) (n = 41) had low levels of individual disaster preparedness, particularly evacuations (86%). None were aware of specific NICU disaster protocols. Patient acuity, role ambiguity, knowledge, and training deficits were major contributors to unpreparedness. Residents viewed their role as system facilitators (eg, performing duties assigned, recruiting other residents, and clerical work like documentation). Resident training requests included disaster preparedness training every NICU rotation (48%) using multidisciplinary simulations (66%), role definition (56%), and written protocols (50%). Despite their unpreparedness, residents (84%) were willing to respond. Conclusion: Pediatric residents lacked knowledge of NICU disaster response but were willing to respond to disasters. Training should include multi-disciplinary simulations that can be refined iteratively to clarify roles, and residents should be involved in planning and execution.

Aim To improve hospitals disaster preparedness during floods. Background The Thai flood disaster in 2011 struck several sectors, including hospitals. It is necessary to build a disaster preparedness system that ensures that hospitals have the capacity to respond effectively to any kind of disaster. Methods This qualitative study was conducted using content analysis. Purposive sampling was used to select 15 participants, including doctors, nurses and other staff involved in disaster preparedness, and semi-structured interviews were conducted with them. The study was reported according to COREQ guidelines. Results Healthcare personnel identified several ways in which flood disaster preparedness of hospitals may be enhanced. Three themes and eight subthemes were identified during the data analysis. The three themes were as follows: 1) ongoing efforts for flood prevention and mitigation at a national level; 2) developing operational guidelines to effectively prevent and resolve flood problems at provincial levels; and 3) increasing the levels of flood readiness at the hospital level. Conclusions The results of this study indicate strategies to help policymakers and health personnel enhance flood disaster preparedness measures at hospitals based on the experiences of hospital personnel involved in one of the worst flood disasters worldwide. Relevance to clinical practice Hospitals alone cannot deal with unpredictable events; they need additional assistance in disaster preparedness. There are three levels at which improving hospital flood disaster preparedness can take place: national, provincial and hospital levels. Nursing professionals participate in hospital disaster preparedness and work with multidisciplinary teams to provide services. Nurses should be prepared for such participation, as their involvement, through tailored services for hospital disaster preparedness, can expand the literature on nursing knowledge to improve clinical outcomes.

Lehulu Tilahun,1 Birhanu Desu,1 Mulusew Zeleke,2 Kirubel Dagnaw,3 Atsedemariam Andualem3 1Wollo University, Department of Emergency and Ophthalmic health, Dessie, Ethiopia; 2Wollo University, Department of Adult Health, Dessie, Ethiopia; 3Wollo University, Department of Comprehensive Nursing, Dessie, EthiopiaCorrespondence: Lehulu Tilahun Tel +251918126376Email lehulut333@gmail.comIntroduction: Globally around 1.6 million individuals have died as a result of disasters per year. These disruptive events that happen in the world each day result in damage to individuals, families, and communities.Methods: An institution-based cross-sectional study was conducted. All frontline health-care providers at the emergency departments of Amhara Regional State Referral Hospitals during the study period were considered as studied subjects. Data were collected through a self-administered technique. Once all essential data were collected, data were coded and entered into epidata manager (v4.6.0.2) statistical software. SPSS version 26 was used to analyze the findings of this paper.Results: The result of this research study showed that 66.7% were males and 33.3% were females with mean age of respondents being 31.2 ± 5.8. Among respondents, 54% (52.9) % did not have an understanding of disaster preparedness. As a result, the majority of participants, 52 (51%), have inadequate knowledge. Most respondents have adequate attitude (57.8%) and only a few, 12 (11.8%), of respondents were very familiar with regard to disaster and disaster handling preparedness. In multivariate logistic regression, receiving training on the subject (P = 0.000, AOR: 15.109. 95% CI: 3.525– 64.769), respondents receiving simulation in the subject of disaster (P = 0.015, AOR: 4.855, 95% CI: 1.366– 17.260) and having a direct personal/professional experience of disaster (P = 0.003, AOR: 5.703, 95% CI: 1.825– 17.823) were significantly associated.Conclusion and Recommendation: Disaster handling preparedness, knowledge and familiarity levels were below those expected for emergency department nurses. Capacity building through training, education and simulation is essential.Keywords: emergency, disaster preparedness, emergency department, nurses

Preparing to evaluate and treat victims of a chemical exposure incident is one aspect of hospital disaster preparedness. Past chemical disasters, including terrorist attacks and industrial or transit accidents, have highlighted the need for hospital planning, preparation, and training. Emergency department and hospital staff members must be familiar with their facility-specific protocols and be trained for their individual roles during these incidents. This article provides a brief review of the requirements and guidelines related to chemical disaster response from a healthcare perspective. Resources for training and the evaluation of chemically contaminated patients are discussed. Decontamination procedures, including pre-hospital and hospital-based decontamination of ambulatory, non-ambulatory, and at-risk patients are also reviewed. Physicians and clinicians, especially in the emergency department, must be familiar with methods of evaluating chemical exposures, identifying substances, recognizing toxidromes, ensuring appropriate personal protective equipment (PPE) use, performing decontamination, and initiating treatments for life-threatening conditions. By understanding the guidelines and resources available, clinicians will be better equipped to safely evaluate and treat chemically exposed or contaminated patients.

Objective: The aim of this study is to determine the level of knowledge of all original and reserve staff about hospital disaster and emergency plan (HDEP) and to investigate the associated factors.Method: 144 staffs in HDEP of 7 hospitals in Bitlis province included in this descriptive study. Knowledge of levels about HDEP of staffs were evaluated with a face-to-face interview accompanied by a questionnaire form. p

In the twenty-first century, severe acute respiratory syndrome (SARS), 2009 A(H1N1) influenza, and Ebola have all placed strains on critical care systems. In addition to the increased patient needs common to many disasters, epidemics may further degrade ICU capability when staff members fall ill, including in the course of direct patient care. In a large-scale pandemic, shortages of equipment and medications can further limit an ICU's ability to provide the normal standard of care. Hospital preparedness for epidemics must include strategies to maintain staff safety, secure adequate supplies, and have plans for triage and prioritization of care when necessary.

Background and aim: Hospital and pre-hospital emergencies are the first lines of coping and dealing with emergencies as well as emerging crises of special status. Developing and improving the readiness of these centers is considered as the main component for success in the Universities of Medical Sciences. The purpose of this study was to assess the preparedness of the incident command system in Qom hospitals Materials and Methods: This descriptive-analytic study was done on 120 senior managers, nursing directors, administrative and financial members of the Crisis Committee of 7 hospitals in Qom. Data were collected using the standard disaster preparedness questionnaire including 4 domains. Data collection was done by the researcher through observation, interview, and committee's documents review. The collected data were analyzed by SPSS 20 software using descriptive-analytical statistics, such as mean, standard deviation, and independent t-test. Results: In general, in the studied hospitals, the mean knowledge of supervisors and members of the Disaster Management Committee was 14.51 and 14.62, respectively, which was not significantly different (P = 0.486). In addition, the mean attitude of the supervisors and members of the Committee was 69.66 and 70.70, respectively, which was not significantly significant (P = 0.437). Regarding practice, the mean score of the practice of the supervisors and members was 9.62 and 12.0, respectively, which was significant (P = 0.045). Conclusion: Proper management of crises is achievable by organizing, coordination, and strengthening of all members of the crisis team.

Disasters, both natural and manmade, are becoming more common. Children often compose up to 30% of those individuals injured in a disaster. The level of preparedness for a surge of pediatric patients after a disaster is variable. Pediatric trauma centers need to be able to take care of multiple children and adults and assist other centers with the care of children. A disaster plan with associated training should be instituted at all hospitals. Collaboration across multiple facilities and agencies is essential in planning. Additionally, it is the duty of medical professionals to train the public in disaster preparedness. Learning through the experiences of others is perhaps the most powerful means of education. A case study of how one hospital handled the deadliest shooting in US history can teach us many lessons.

Recent studies have demonstrated that early transfusion of plasma or RBCs improves survival in patients with severe trauma and hemorrhagic shock. Time to initiate transfusion is the critical factor. It is essential that transfusion begin in the prehospital environment when transport times are longer than approximately 15 to 20 minutes. Unfortunately, logistic constraints severely limit the use of blood products in the prehospital setting, especially in military, remote civilian, and mass disaster circumstances, where the need can be most acute. US military requirements for logistically supportable blood products are projected to increase dramatically in future conflicts. Although dried plasma products have been available and safely used in a number of countries for over 20 years, there is no dried plasma product commercially available in the United States. A US Food and Drug Administration-approved dried plasma is urgently needed. Considering the US military, disaster preparedness, and remote civilian trauma perspectives, this is an urgent national health care issue.

In 2016 and 2017, there were earthquakes greater than 5.0 in magnitude on the Korean Peninsula, which has previously been considered an earthquake-free zone. Patients with chronic kidney disease are particularly vulnerable to earthquakes, as the term "renal disaster" suggests. In the event of a major earthquake, patients on hemodialysis face the risk of losing maintenance dialysis due to infrastructure disruption. In this review, we share the experience of an earthquake in Pohang that posed a serious risk to patients on hemodialysis. We review the disaster response system in Japan and propose a disaster preparedness plan with respect to hemodialysis. Korean nephrologists and staff in dialysis facilities should be trained in emergency response to mitigate risk from natural disasters. Dialysis staff should be familiar with the action plan for natural disaster events that disrupt hemodialysis, such as outages and water treatment system failures caused by earthquakes. Patients on hemodialysis also need to be educated about disaster preparedness. In the event of a disaster situation that results in dialysis failure, patients need to know what to do. At the local and national government level, long-term preparations should be made to handle renal disaster and patient safety logistics. Moreover, Korean nephrologists should also be prepared to manage cardiovascular disease and diabetes in disaster situations. Further evaluation and management of social and national disaster preparedness of hemodialysis units to earthquakes in Korea are needed.

Background and objectives Blood is a critical resource for responding to mass casualty incidents (MCI). The main framework for transfusion preparedness is the American Association of Blood Bank (AABB) Disaster Operation Handbook. A disaster preparedness plan for co-ordinated blood supply was issued in Italy in 2016. Aim To assess the level of preparedness of the Transfusion Centers (TS) in the Piedmont region, to evaluate the applicability of AABB checklist and to evaluate the application of the Italian plan. Materials and methods We surveyed all the Regional Transfusion Centers (TS) using the AABB checklist, addressing 74 priority action items grouped according to 16 preparedness domains. The Italian 2016 plan has been considered the regulatory cut-off and hospitals were stratified based on the type and the TS workload. A principal component analysis (PCA) was conducted to summarize the variance among centres. Results Twenty-one out of 25 TS agreed to participate. Eighty-one % were at high and 18% were at medium level of preparedness. All but two centres were above the cut-off determined by the Italian law. A significant better preparedness was found in medium size hospitals compared to bigger and smaller hospitals. Other than that, the different TS showed a quite homogeneous distribution of preparedness variance. Conclusions This study demonstrated a good level of preparedness in the Piemonte TS, above the Italian law requirements in the majority of TS. The AABB checklist could be used to highlight gaps and needs in the regional TS networks in case of emergency crisis.

Background: Hospitals, as the first and most important treatment centers for injured people, should be prepared before the crisis to provide health care services in the best possible manner, with appropriate and prompt action. The current study aimed at investigating the accident and disaster preparedness of hospitals affiliated to Jundishapur University of Medical Sciences in Ahvaz, Iran. Materials and Methods: The statistical population of the current descriptive, cross sectional study was all hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences in 2017. The main tool to collect information in the study was the checklist of preparedness for disasters designed by Hojjat et al. A group of 20 faculty members of the Jundishapur University of Medical Sciences evaluated the checklist and confirmed its validity. Also, the reliability of the instrument was evaluated using a test-retest method on one of the research units based on Kappa test with a value of 0.8 in acceptable range. Data were collected and coded with SPSS software version 19. Results: The highest level of disaster preparedness at Jundishapur University of medical sciences in Ahvaz belonged to human inferiority with an average score of 67.66±8; 16 of 100, and the lowest belonged to the emergency areas with an average score of 3.75±0.77 or 43 of 100. Imam Khomeini Hospital was in a better status than the other hospitals in terms of emergency, reception, discharging and transferring, traffic, and communication. In terms of education, Abuzar Hospital had the highest level of preparedness; and regarding support and management of health care practices, Salamat Hospital had the highest level for disaster preparedness. Conclusion: The preparedness of hospitals affiliated to Jondishapour University was in moderate status and Imam Khomeini Hospital had the highest level of accident and disaster preparedness.

Background: A powerful earthquake in Yogyakarta, causing major damage and many deaths. Children with autism are more vulnerable and have a greater risk of earthquake because they are have an intellectual, social and verbal disability to safe life independently. Objective: This research discussed the influence of play therapy on learning of disaster mitigation for children with autism. Method: This research used qualitative descriptive design and consider a sample of 30 children with autism in SLB N Pembina Yogyakarta. Play therapy in this research use drawing and coloring methods, also watching video about disaster preparedness. Results: Play therapy could effectively be applied as earthquake mitigation lesson to children with autism in SLB N Pembina Yogyakarta. Before interventions, there were 2 children (7%) able to draw on actions when an earthquake occurred, and increased to 19 children (63,33%) after interventions. Conclusion: Play therapy could be effectively applied to children with autism as earthquake disaster mitigation showed by an increase of children’s drawing and coloring ability on actions when an earthquake occurred for as much as 56,33%. Keyword: Children with autism, mitigation ability, play therapy

Prasit Wuthisuthimethawee,1 Rapeeporn Rojsaengroeng,1,2 Torpong Krongtrivate3 1Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; 2Department of Emergency Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand; 3Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat, ThailandCorrespondence: Prasit WuthisuthimethaweeDepartment of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, ThailandTel +66 74451705Fax +66 74451704Email Prasit0552002@yahoo.comIntroduction: Hospital preparedness is a key component to mitigate the effects of mass casualty incidents (MCIs) and disasters. Improving hospital preparedness requires an assessment of the country’s current health system capacity, readiness, and preparedness. Although a variety of assessment tools exist, none are entirely suitable for Thailand’s healthcare system.Objective: To develop an assessment tool to evaluate hospital preparedness for MCI and disaster in Thailand.Methods: A cross-sectional study was conducted from 1 March 2015 to December 2016. The contents of the first drafted tool were prepared based on evidence from a systematic search of electronic databases published up to 31 December 2014. Key elements identification, extraction, and further organization were based on the World Health Organization health system framework. Validity was tested by experts and emergency management personnel in four domains using a 5-point scale evaluation form. The feasibility of using this assessment tool was carried out in 41 hospitals on a voluntary basis. The tool was considered valid if the item-objective congruence (IOC) index results were at least 0.6 and feasible for median values of at least 4.Results: Seventy-six full texts and guidelines out of 5869 titles and abstracts from a systematic search were enrolled in the study. A constructive literature review was performed to develop a hospital assessment tool. The IOC index results of the assessment tool components were 1.0, 0.9, 0.7, and 1.0 in framework appropriateness, relevance of items, clearness, and usefulness, respectively. The median (interquartile range) values of framework appropriateness, relevance of items, clearness, and usefulness were 4.0 (4.0‒5.0), 4.3 (4.3‒4.5), 4.0 (4.0‒4.0), and 5.0 (4.0‒5.0), respectively.Conclusion: An assessment tool to evaluate hospital MCI and disaster preparedness based on the WHO health system framework was valid and feasible at the national level of Thailand.Keywords: hospital assessment tool, disaster, mass casualty incident

Background:Every year, Puerto Rico faces a hurricane season fraught with potentially catastrophic structural, emotional and health consequences. In 2017, Puerto Rico was hit by Hurricane Maria, the largest natural disaster to ever affect the island. Several studies have estimated the excess morbidity and mortality following Hurricane Maria in Puerto Rico, yet no study has comprehensively examined the underlying health system weaknesses contributing to the deleterious health outcomes.Methods:A qualitative case study was conducted to assess the ability of the UPR health system to provide patient care in response to Hurricane Maria. An established five key resilience framework and inductive analysis was used to identify factors that affected health system resilience. Thirteen Emergency Medicine Physicians, Family Medicine Physicians, and Hospital Administrators in a University of Puerto Rico (UPR) Community Hospital were interviewed as part of our study.Results:Of the five key resiliency components, three domains were notably weak with respect to UPR's resiliency. Prior to the Hurricane, key personnel at the UPR hospital wereunawareof the limited capacity of back-up generators at hospitals and were ill-prepared to transfer ICU patients to appropriate hospitals. Post Hurricane, the hospital facedself-regulationchallenges when triaging the provision of Hurricane-related emergency services with delivering core health services, in particular for patients with chronic conditions. Finally, during and after the Hurricane,integrationof patient care coordination between the UPR hospital ambulances, neighboring hospitals, and national and state government was suboptimal. The two remaining resiliency factors, addressingdiverseneeds and systemadaptivenessin a time of crisis, were seen as strengths.Conclusions:Hurricane Maria exposed weaknesses in the Puerto Rican health system, notably the lack of awareness about the limited capacity of backup generators, poor patient care coordination, and interruption of medical care for patients with chronic conditions. As in other countries, the current COVID epidemic is taxing the capacity of the Puerto Rico health system, which could increase the likelihood of another health system collapse should another hurricane hit the island. Therefore, a resilience framework is a useful tool to help health systems identify areas of improvement in preparation for possible natural disasters.

In the current study, we sought to identify special needs and safe evacuation conditions for children with neurodevelopmental disorders (CNDs) along Japan’s tsunami-prone Pacific coast. A survey and spatial analysis were used to collect data of CNDs (n = 47) and their caregivers. Areas predicted to be flooded in a tsunami, as well as evacuation routes to emergency shelters for vulnerable people (ESVPs), were mapped using geographic information systems (GIS). Our results showed that five professional staff were needed to support 33 CNDs requiring 135.9 m2 of ESVP space. Critical safety factors were altitude, vertical evacuation, accessibility to ESVPs, and nonexistence of estuaries in the direction of evacuation. GIS-based spatial analysis and evacuation modeling for disaster preparedness and training plans that involve nurses are essential.

School textbooks are one of the main sources for teaching and learning in an education system. This study aims to investigate the representation of disasters in school textbooks for the children with intellectual disabilities (ID) in the education system in Iran.This study uses a qualitative content analysis method. All school textbooks for students with ID in the education year 2019-2020 in Iran were collected. Among the whole 164 textbooks, 18 had content about hazards. Data were analyzed qualitatively by MAXQDA 2018 software.Textbooks in most grades cover the topic of disasters triggered by natural hazards including geophysical (earthquakes), hydrological (floods), climatological (extreme temperatures, and drought), meteorological (storms/wave surges) and biological (epidemics and insect/animal plagues). Moreover, there are various topics of disaster risk management in the textbooks including mitigation, preparedness, and response.Natural hazards are well covered in school textbooks for students with ID in Iran. However, more content about sheltering in disasters, reunification, as well as disasters’ response and recovery will help children with ID in Iran to perform better during and after disasters. Moreover, the textbooks in several grades provide some debates on the prevention and the spread of infectious diseases for preparedness against epidemics. The COVID-19 pandemic and the significance of preparedness of vulnerable groups against pandemics evidence that school textbooks are a key means to transfer the information of preparedness in emergencies of all sorts to all children including children with ID.

Influenza and COVID-19 are infectious diseases with significant burdens. Information and awareness on preventative techniques can be spread through the use of social media, which has become an increasingly utilized tool in recent years. This study developed a dynamic transmission model to investigate the impact of social media, particularly tweets via the social networking platform, Twitter on the number of influenza and COVID-19 cases of infection and deaths. We modified the traditional Susceptible-Exposed-Infectious-Recovered (SEIR-V) model with an additional social media component, in order to increase the accuracy of transmission dynamics and gain insight on whether social media is a beneficial behavioral intervention for these infectious diseases. The analysis found that social media has a positive effect in mitigating the spread of contagious disease in terms of peak time, peak magnitude, total infected, and total death; and the results also showed that social media’s effect has a non-linear relationship with the reproduction number \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${R}_{0}$$\end{document}R0 and it will be amplified when a vaccine is available. The findings indicate that social media is an integral part in the humanitarian logistics of pandemic and emergency preparedness, and contributes to the literature by informing best practices in the response to similar disasters.