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Atmospheric rivers (ARs) and Santa Ana winds (SAWs) are impactful weather events for California communities. Emergency planning efforts and resource management would benefit from extending lead times of skillful prediction for these and other types of extreme weather patterns. Here we describe a methodology for subseasonal prediction of impactful winter weather in California, including ARs, SAWs and heat extremes. The hybrid approach combines dynamical model and historical information to forecast probabilities of impactful weather outcomes at weeks 1–4 lead. This methodology uses dynamical model information considered most reliable, that is, planetary/synoptic‐scale atmospheric circulation, filters for dynamical model error/uncertainty at longer lead times and increases the sample of likely outcomes by utilizing the full historical record instead of a more limited suite of dynamical forecast model ensemble members. We demonstrate skill above climatology at subseasonal timescales, highlighting potential for use in water, health, land, and fire management decision support. Plain Language Summary: California winter weather can alternate between very wet conditions from atmospheric rivers making landfall along the Pacific coast to hot, dry, and windy conditions brought by Santa Ana winds blowing in from the Southwest interior. Atmospheric rivers are important for water resources while also causing flooding, whereas Santa Ana winds are often associated with wildfire, especially following prolonged dry periods. Preparing for these types of weather events is important for managing resources and protecting life and property, yet reliable forecasts beyond about 7–10 days remain a challenge. We have developed a new prediction system that combines information about approaching atmospheric weather patterns from weather forecast models along with historical information relating those patterns to impacts over California to predict the likelihood of impactful weather at 1–4 weeks lead time. By extending the window of opportunity to take management action, this new approach should aid in resource and emergency planning in water, land, and fire sectors as well as protecting residents through improved warning systems. Key Points: A hybrid dynamical‐statistical model is described for 1–4‐week forecasts of impactful California winter weather using circulation regimesThis hybrid framework reduces the number of forecasts produced, but the ones issued can be interpreted with higher confidenceThis new methodology provides skillful subseasonal forecasts with potential to improve early warnings for impactful weather events [ABSTRACT FROM AUTHOR]

San Francisco implemented one of the most intensive, comprehensive, multipronged COVID-19 pandemic responses in the United States using 4 core strategies: (1) aggressive mitigation measures to protect populations at risk for severe disease, (2) prioritization of resources in neighborhoods highly affected by COVID-19, (3) timely and adaptive data-driven policy making, and (4) leveraging of partnerships and public trust. We collected data to describe programmatic and population-level outcomes. The excess all-cause mortality rate in 2020 in San Francisco was half that seen in 2019 in California as a whole (8% vs 16%). In almost all age and race and ethnicity groups, excess mortality from COVID-19 was lower in San Francisco than in California overall, with markedly diminished excess mortality among people aged >65 years. The COVID-19 response in San Francisco highlights crucial lessons, particularly the importance of community responsiveness, joint planning, and collective action, to inform future pandemic response and advance health equity. [ABSTRACT FROM AUTHOR]

Predicting sediment yield from recently burned areas remains a challenge but is important for hazard and resource management as wildfire impacts increase. Here we use lidar‐based monitoring of two fires in southern California, USA to study the movement of sediment during pre‐rainfall periods and postfire periods of flooding and debris flows over multiple storm events. Using a data‐driven approach, we examine the relative importance of terrain, vegetation, burn severity, and rainfall amounts through time on sediment yield. We show that incipient fire‐activated dry sediment loading and pre‐fire colluvium were rapidly flushed out by debris flows and floods but continued erosion occurred later in the season from soil erosion and, in ∼9% of catchments, from shallow landslides. Based on these observations, we develop random forest regression models to predict dry ravel and incipient runoff‐driven sediment yield applicable to small steep headwater catchments in southern California. Plain Language Summary: Wildfire makes watersheds more susceptible to hazardous flash flooding and debris flows, yet characterization and prediction of these hazards remains limited. In this study, we used repeat airborne laser mapping to quantify the movement of sediment in steep burn areas during initial dry periods and subsequent erosion from runoff events. Based on these observations, we developed two predictive models: one to predict the filling of channels with sediment prior to rainfall and a second one to predict erosion by debris flows and floods during initial storm events, which showed improvement over another commonly used model. After initial runoff events, much of the available sediment in channels was transported downstream, however small landslides and extensive erosion of soils across the landscape continued to supply sediment to floods and debris flows, in line with studies elsewhere showing continued debris flow activity despite reduced sediment in channels. Our study demonstrates that airborne laser mapping together with data‐driven modeling offer opportunities to increase predictive ability of post‐fire erosion and such approaches should be further explored in regions such as northern California, where fire is expanding and models of post‐fire erosion need to be tested and refined. Key Points: Postfire dry and wet sediment transport were quantified with lidar and dominant controls were identified using random forest regressionSlope and sediment supply, including dry ravel, were the strongest controls on initial sediment yield by debris flows and floodsContinued sediment bulking occurred from soil erosion and patchy mass wasting later in the wet season as channels became supply limited [ABSTRACT FROM AUTHOR]

Background: People with HIV (PWH) are disproportionately vulnerable to the impacts of wildfires, given the need for frequent access to healthcare systems, higher burden of comorbidities, higher food insecurity, mental and behavioral health challenges, and challenges of living with HIV in a rural area. In this study, we aim to better understand the pathways through which wildfires impact health outcomes among PWH. Methods: From October 2021 through February 2022, we conducted individual semi-structured qualitative interviews with PWH impacted by the Northern California wildfires and clinicians of PWH who were impacted by wildfires. The study aims were to explore the influence of wildfires on the health of PWH and to discuss measures at the individual, clinic, and system levels that helped to mitigate these impacts. Results: We interviewed 15 PWH and 7 clinicians. While some PWH felt that surviving the HIV epidemic added to their resilience against wildfires, many felt that the wildfires compounded the HIV-related traumas that they have experienced. Participants outlined five main routes by which wildfires negatively impacted their health: (1) access to healthcare (medications, clinics, clinic staff), (2) mental health (trauma; anxiety, depression, or stress; sleep disturbances; coping strategies), (3) physical health (cardiopulmonary, other co-morbidities), (4) social/economic impacts (housing, finances, community), and (5) nutrition and exercise. The recommendations for future wildfire preparedness were at the (1) individual-level (what to have during evacuation), (2) pharmacy-level (procedural, staffing), and (3) clinic- or county-level (funds and vouchers; case management; mental health services; emergency response planning; other services such as telehealth, home visits, home laboratory testing). Conclusions: Based on our data and prior research, we devised a conceptual framework that acknowledges the impact of wildfires at the community-, household-, and individual-level with implications for physical and mental health outcomes among PWH. These findings and framework can help in developing future interventions, programs, and policies to mitigate the cumulative impacts of extreme weather events on the health of PWH, particularly among individuals living in rural areas. Further studies are needed to examine health system strengthening strategies, innovative methods to improve access to healthcare, and community resilience through disaster preparedness. Trial registration: N/A. [ABSTRACT FROM AUTHOR]

Objectives. To assess wildfire risks to California inpatient health care facilities in 2022. Methods. Locations of inpatient facilities and associated inpatient bed capacities were mapped in relation to California Department of Forestry and Fire Protection fire threat zones (FTZs), which combine expected fire frequency with potential fire behavior. We computed the distances of each facility to the nearest high, very high, and extreme FTZs. Results. Half (107 290 beds) of California's total inpatient capacity is within 0.87 miles of a high FTZ and 95% (203 665 beds) is within 3.7 miles of a high FTZ. Half of the total inpatient capacity is within 3.3 miles of a very high FTZ and 15.5 miles of an extreme FTZ. Conclusions. Wildfires threaten a large number of inpatient health care facilities in California. In many counties, all health care facilities may be at risk. Public Health Implications. Wildfires in California are rapid-onset disasters with short preimpact phases. Policies should address facility-level preparedness including smoke mitigation, sheltering measures, evacuation procedures, and resource allocation. Regional evacuation needs, including access to emergency medical services and patient transportation, must also be considered. (Am J Public Health. 2023;113(5):555–558. https://doi.org/10.2105/AJPH.2023.307236) [ABSTRACT FROM AUTHOR]

Objective: To explore in a sample of school nurses (SN) in California the impact of the COVID‐19 pandemic on school nurse health services, how school nurses mitigated the impact of COVID‐19, and moral distress levels among school nurses. Design and Methods: Nineteen (N = 19) school nurses who work in K‐12 schools in California, USA participated in a mixed‐methods approach involving qualitative descriptive design, inductive content analysis, and descriptive statistics. Interviews were conducted in August and September 2021. Results: Five themes emerged: (1) role of the SN during the COVID‐19 pandemic, (2) coordination with school administration, (3) COVID‐19 related challenges and disruptions to care, (4) moral distress, and (5) coping during the pandemic. Conclusion: The pandemic had a profound impact on school nurses. This study provides school nurse perspectives of the impact of COVID‐19 on services they delivered, the unique skills of school nurses essential to mitigation strategies, and moral distress school nurses encountered during the pandemic. Understanding the important role school nurses had during the pandemic is paramount to fully contextualize the contributions they made within public health nursing practice and inform preparedness for future pandemics. [ABSTRACT FROM AUTHOR]

Previous research found that National Flood Insurance Program (NFIP) premiums collected in some U.S. states, including California, have far exceeded damage payments. However, this finding raises the question of whether such an imbalance represents systematically good flood management or, instead, merely short‐term hydrologic good luck. This study investigated patterns in flood losses on structures that pre‐date and post‐date the first available flood maps ("pre‐Flood Insurance Rate Map [FIRM]" vs. "post‐FIRM") in California, several peer states, and nationwide. California has a larger inheritance of pre‐FIRM structures than the national average, apparently reflecting development during the latter half of the 20th Century but before most Federal Emergency Management Agency (FEMA) flood maps. Pre‐FIRM properties are a disproportionate cost burden on the system, and the number of pre‐FIRM policies has declined over time, but only slowly. Local patterns in pre‐FIRM claims suggest targeted areas for enhanced mitigation efforts, including buyouts. Conversely, we find that claims on post‐FIRM policies are a reasonable metric of good floodplain management and enforcement, and California's 38% of post‐FIRM policies generated just 24% of the state's NFIP claims. Local "post‐FIRM claim hotspots" suggest areas to examine more closely. California continues to be a net payer into the National Flood Insurance Program, with $102 million in payouts 2009–2018 versus $2.3 billion in premiums collected, or 4.5 cents of premiums collected for every dollar of premiums. In California, its peer states, and nationwide, future management of flood risk depends on: (1) continued investment in flood control and mitigation of existing floodplain structures, and (2) prudent planning and limitations on new floodplain and coastal development. [ABSTRACT FROM AUTHOR]

Context.--: Stanford Pathology began stepwise subspecialty implementation of whole slide imaging (WSI) in 2018 soon after the first US Food and Drug Administration approval. In 2020, during the COVID-19 pandemic, the Centers for Medicare & Medicaid Services waived the requirement for pathologists to perform diagnostic tests in Clinical Laboratory Improvement Amendments (CLIA)-licensed facilities. This encouraged rapid implementation of WSI across all surgical pathology subspecialties. Objective.--: To present our experience with validation and implementation of WSI at a large academic medical center encompassing a caseload of more than 50 000 cases per year. Design.--: Validation was performed independently for 3 subspecialty services with a diagnostic concordance threshold above 95%. Analysis of user experience, staffing, infrastructure, and information technology was performed after department-wide expansion. Results.--: Diagnostic concordance was achieved in 96% of neuropathology cases, 100% of gynecologic pathology cases, and 98% of immunohistochemistry cases. After full implementation, 8 high-capacity scanners were operational, with whole slide images generated on greater than 2000 slides per weekday, accounting for approximately 80% of histologic slides at Stanford Medicine. Multiple modifications in workflow and information technology were needed to improve performance. Within months of full implementation, most attending pathologists and trainees had adopted WSI for primary diagnosis. Conclusions.--: WSI across all surgical subspecialities is achievable at scale at an academic medical center; however, adoption required flexibility to adjust workflows and develop tailored solutions. WSI at scale supported the health and safety of medical staff while facilitating high-quality patient care and education during COVID-19 restrictions. [ABSTRACT FROM AUTHOR]

Background: The relationship between the risk of exposure to environmental hazards and the emergency preparedness of nursing homes is not wellunderstood. This study evaluates the association between wildfire exposure risk and nursing home emergency preparedness. Methods: From a sample of Centers for Medicare & Medicaid Services (CMS) certified nursing homes in California, we determined the prevalence of “exposed” facilities that were located within 5 km of a wildfire risk area, as informed by a field-tested model. Among the 1182 nursing homes, we identified emergency preparedness deficiencies from January 2017 to December 2019. We estimated associations between exposure and emergency preparedness deficiencies using unadjusted and adjusted generalized estimating equations with logistic and negative binomial distributions. Results: A greater percentage of the 495 exposed facilities had at least one emergency preparedness deficiency than the 687 unexposed facilities (83.9% vs 76.9%). The mean (3.6 vs 3.2) and median (3 vs 2) numbers of emergency preparedness deficiencies were also greater for exposed facilities. In both the unadjusted and adjusted analyses, exposure to wildfire risk was significantly associated with the likelihood of at least one emergency preparedness deficiency (adjusted odds ratio 1.52, p-value 0.007). There was a positive but not statistically significant association between exposure and the number of emergency preparedness deficiencies assigned to a nursing home (adjusted rate ratio 1.12, p-value 0.062). These results were consistent in analyses that used more stringent distance- and severity-thresholds to define exposure status. Conclusion: California nursing homes at heightened risk of exposure to wildfires have poorer emergency preparedness than unexposed facilities. These findings suggest that nursing home management and staff may be unaware of important environmental risks to which their facilities are exposed. Improved integration of nursing homes into community disaster planning may better align facility preparedness with surrounding wildfire risk. [ABSTRACT FROM AUTHOR]

In California, more frequent, intense, and destructive wildfires have prompted public health departments to enhance disaster response plans as evacuations and shelter needs increase. In addition, individuals utilizing shelters have increasingly complex medical and behavioral health needs and are accessing shelters for longer periods of time. Public health nurses (PHNs) are often called to staff disaster shelters but may have less recent experience in, or comfort with, direct patient care. Many health departments are experiencing challenges developing sustainable training infrastructure that prepares PHNs to deliver direct patient care in disaster shelters. Partnering with academic institutions can address this challenge. This article describes a partnership between a regional collaborative of health jurisdictions and a public university to train public health nurses to work in disaster shelters. The training demonstrates a sustainable way to instruct public health nurses while also highlighting the potential of partnerships between academic institutions and local health departments to address disaster preparedness and response needs in a community. Public health nurses are essential to public health preparedness and providing additional training can augment their ability to respond to disasters. [ABSTRACT FROM AUTHOR]

Unnatural disasters, such as floods and wildfires, are making many areas difficult to inhabit. For relocation to unfold in a safer and more equitable way, it must be done in a manner that (1) aligns with community values in each locality, (2) navigates legal barriers to managed retreat, and (3) creates blue-sky funding for adaptation, including managed retreat planning and implementation. This paper argues that developers continuing to build in climate vulnerable areas could and should help cover the risk of their actions. Part I lays out the legal importance of planning for retreat, as well as the need for initial funding for community-level planning and experienced personnel. Few scholars have explored options for municipalities to fund difficult conversations about and initial steps towards managing retreat. Thus, Part II explores how community benefit agreements between communities and developers in climate-vulnerable areas could play a role in bridging the gap between research and implementation. Part II also introduces the idea of a climate resilience development fee, which could provide the needed blue-sky funding to implement managed retreat. Part III analyzes the validity of a climate resilience impact fee in California and Florida, two states in which the consequences of climate change are severe enough for communities to begin to consider managed retreat. [ABSTRACT FROM AUTHOR]

Human mobility datasets collected from personal mobile device locations are integral to understanding how states, counties, and cities have collectively adapted to pervasive social disruption stemming from the COVID-19 pandemic. However, while indigenous tribal communities in the United States have been disproportionately devastated by the pandemic, the relatively sparse populations and data available in these hard-hit tribal areas often exclude them from mobility studies. We explore the effects of sparse mobility data in untangling the often inter-correlated relationship between human mobility, distancing orders, and case growth throughout 2020 in tribal and rural areas of California. Our findings account for data sparsity imprecision to show: 1) Mobility through legal tribal boundaries was unusually low but still correlated highly with case growth; 2) Case growth correlated less strongly with mobility later in the the year in all areas; and 3) State-mandated distancing orders later in the year did not necessarily precede lower mobility medians, especially in tribal areas. It is our hope that with more timely feedback offered by mobile device datasets even in sparse areas, health policy makers can better plan health emergency responses that still keep the economy vibrant across all sectors. [ABSTRACT FROM AUTHOR]

Mpox, formerly known as monkeypox, emerged as a viral zoonotic disease in 2022. The World Health Organization (WHO) declared a global pandemic in July 2022. Through the U.S. Food and Drug Administration's emergency use authorization, JYNNEOS became the dominant vaccine for prevention of mpox. California leads the nation in the number of U.S. cases, and the outbreak created opportunities for a nurse practitioner–led pop-up vaccination clinic in Los Angeles County. Interprofessional teamwork with pharmacists and public health officials increased the number of individuals vaccinated. By November, the WHO released operational planning guidelines. Nurse practitioners can use these guidelines in anticipation of the next pandemic. [ABSTRACT FROM AUTHOR]

Upon request from tribal nations, and as part of the Centers for Disease Control and Prevention's (CDC's) emergency response, CDC staff provided both remote and on-site assistance to tribes to plan, prepare, and respond to the COVID-19 pandemic. From April 2, 2020, through June 11, 2021, CDC deployed a total of 275 staff to assist 29 tribal nations. CDC staff typically collaborated in multiple work areas including epidemiology and surveillance (86%), contact tracing (76%), infection prevention control (72%), community mitigation (72%), health communication (66%), incident command structure (55%), emergency preparedness (38%), and worker safety (31%). We describe the activities of CDC staff in collaboration with 4 tribal nations, Northern Cheyenne, Hoopa Valley, Shoshone-Bannock, and Oglala Sioux Tribe, to combat COVID-19 and lessons learned from the engagement. [ABSTRACT FROM AUTHOR]

The evaluation of communities' vulnerability to prolonged power outages offers valuable insights for prioritizing improvements in infrastructure resilience, thereby alleviating societal consequences. This study proposes a data-driven approach aiming at developing a Social Vulnerability Index (SoVI) to prolonged power outages leveraging three county-level datasets in California including (1) demographic features, (2) power outage factors, and (3) backup power factors. Furthermore, the study conducts a sensitivity analysis on three distinct datasets under two scenarios (Scenario 1: the current SoVI in 2022, Scenario 2: the prediction of SoVI in the year 2030). The results of Scenario 1 indicate that the counties with more affected customers, the number of power outages, and less education attainment tend to be more vulnerable to power outages in 2022. Scenario 1 reveals that the number of affected customers and power outages are the primary features influencing around 29% and 18% of counties, while educational attainment, public Electric Vehicles (EVs) chargers, and homes with rooftop photovoltaic (PV) substantially impact approximately 32%, 11%, and 8% of counties, respectively. However, in Scenario 2, crucial factors affecting the anticipated SoVI in 2030 include public EV chargers, houses with rooftop PV, power outages, and adults living alone. In contrast to Scenario 1, the prevalence of adults living alone has emerged as a notable factor impacting SoVI in 2030, while both scenarios underscore the pivotal role of EV chargers in influencing SoVI concerning power outages. The proposed SoVI facilitates informed policy decisions and infrastructure improvements in energy resilience, resource allocation, and disaster preparedness, contributing valuable insights for targeted interventions in these domains. • A data-driven approach was proposed to quantify the social vulnerability index (SoVI) to power outages. • This paper applies Principal Component Analysis (PCA) to identify the most correlated features from county-level datasets. • The paper conducts a sensitivity analysis to predict SoVI in2030 and evaluate how counties' dynamics change over time. • This paper provides insights into how policymakers can reduce the social vulnerability to power outages in California. [ABSTRACT FROM AUTHOR]

Due to the mixed distribution of buildings and vegetation, wildland-urban interface (WUI) areas are characterized by complex fuel distributions and geographical environments. The behavior of wildfires occurring in the WUI often leads to severe hazards and significant damage to man-made structures. Therefore, WUI areas warrant more attention during the wildfire season. Due to the ever-changing dynamic nature of California's population and housing, the update frequency and resolution of WUI maps that are currently used can no longer meet the needs and challenges of wildfire management and resource allocation for suppression and mitigation efforts. Recent developments in remote sensing technology and data analysis algorithms pose new opportunities for improving WUI mapping methods. WUI areas in California were directly mapped using building footprints extracted from remote sensing data by Microsoft along with the fuel vegetation cover from the LANDFIRE dataset in this study. To accommodate the new type of datasets, we developed a threshold criteria for mapping WUI based on statistical analysis, as opposed to using more ad-hoc criteria as used in previous mapping approaches. This method removes the reliance on census data in WUI mapping, and does not require the calculation of housing density. Moreover, this approach designates the adjacent areas of each building with large and dense parcels of vegetation as WUI, which can not only refine the scope and resolution of the WUI areas to individual buildings, but also avoids zoning issues and uncertainties in housing density calculation. Besides, the new method has the capability of updating the WUI map in real-time according to the operational needs. Therefore, this method is suitable for local governments to map local WUI areas, as well as formulating detailed wildfire emergency plans, evacuation routes, and management measures. [ABSTRACT FROM AUTHOR]

Advanced Quantitative Precipitation Information (AQPI) is a synergistic project that combines observations and models to improve monitoring and forecasts of precipitation, streamflow, and coastal flooding in the San Francisco Bay Area. As an experimental system, AQPI leverages more than a decade of research, innovation, and implementation of a statewide, state-of-the-art network of observations, and development of the next generation of weather and coastal forecast models. AQPI was developed as a prototype in response to requests from the water management community for improved information on precipitation, riverine, and coastal conditions to inform their decision-making processes. Observation of precipitation in the complex Bay Area landscape of California's coastal mountain ranges is known to be a challenging problem. But, with new advanced radar network techniques, AQPI is helping fill an important observational gap for this highly populated and vulnerable metropolitan area. The prototype AQPI system consists of improved weather radar data for precipitation estimation; additional surface measurements of precipitation, streamflow, and soil moisture; and a suite of integrated forecast modeling systems to improve situational awareness about current and future water conditions from sky to sea. Together these tools will help improve emergency preparedness and public response to prevent loss of life and destruction of property during extreme storms accompanied by heavy precipitation and high coastal water levels—especially high-moisture laden atmospheric rivers. The Bay Area AQPI system could potentially be replicated in other urban regions in California, the United States, and worldwide. [ABSTRACT FROM AUTHOR]

Emergency departments (EDs) are the point of entry for infectious diseases, making it necessary to reevaluate current practices and make adjustments to decrease transmission when presented with a novel viral infection. This article discusses strategies implemented in the ED to prevent transmission of coronavirus disease-2019 (COVID-19) while identifying areas of needed change in creating a safe environment for patients, health care workers, and ancillary staff. A team approach is ultimately necessary for success; therefore, development of interprofessional teams was formed to mitigate any obstacles. Dissemination of the most current information regarding proper personal protective equipment use, triaging, patient flow, and treatment areas were implemented with weekly emails, videoconferencing, and daily huddles. Developing an efficient triage screening process, redesigning patient flow, and cohorting of patients and staff to a geographical location are essential to minimize transmission. Constant reevaluation of processes is necessary to meet all the needs of patients and health care staff to prevent the spread of COVID-19. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has overwhelmed health systems around the globe, and intensified the lethality of social and political inequality. In the United States, where public health departments have been severely defunded, Black, Native, Latinx communities and those experiencing poverty in the country's largest cities are disproportionately infected and disproportionately dying. Based on our collective ethnographic work in three global cities in the U.S. (San Francisco, Los Angeles, and Detroit), we identify how the political geography of racialisation potentiated the COVID-19 crisis, exacerbating the social and economic toll of the pandemic for non-white communities, and undercut the public health response. Our analysis is specific to the current COVID19 crisis in the U.S, however the lessons from these cases are important for understanding and responding to the corrosive political processes that have entrenched inequality in pandemics around the world. [ABSTRACT FROM AUTHOR]

Purpose: This paper describes the educational experiences of children and youth (aged 3–20) with disabilities during school closures resulting from the 2017 Northern California wildfires. Students with disabilities are particularly vulnerable to the adverse impacts of disaster, yet the effects of school closures on these children remains understudied. This study identifies considerations for students with disabilities and their families post-disaster. Design/methodology/approach: An inductive, qualitative approach was used for the study design, methodology and analysis. In-depth interviews were conducted with parents of 14 students with disabilities about their experiences during and following school closures. All of these children had missed between a week and over a month of school as a result of the wildfires. Thematic analysis was used to code data and identify four themes present across the data. Findings: Our findings indicate that children and youth with disabilities experienced disruptions in school-based services; lost previously acquired skills; exhibited negative health and behavioral issues; had difficulties adapting to new, unfamiliar routines and were saddened by lost social connections. Additionally, findings pinpoint the importance of social connections while schools were closed, the benefits of resuming school which included access to responsive school staff, as well as challenges faced by children with disabilities and their families once schools reopened. Originality/value: Families of children with disabilities, as illustrated in this study, often must transverse a different post-disaster landscape. Schools should assist them in navigating that landscape so students with disabilities can experience a more equitable return to education post-disaster. [ABSTRACT FROM AUTHOR]

Adult day centers (ADCs) are nonresidential settings that support the health and social needs of vulnerable older adults. Due to ADCs' congregate nature and participants' compromised health status, many ADCs have been forced to close during the COVID-19 pandemic. It is unknown how closures have impacted service delivery at ADCs. Guided by the Resiliency Activation Framework, we (a) identified consequences resulting from closures of ADCs during the COVID-19 pandemic and (b) described factors that have enabled the ADC community to remain resilient in the wake of challenges brought on by the pandemic. We conducted 2 focus groups in California (n = 12), and individual interviews with ADC staff members (n = 8) in 7 other states. The results of a directed content analysis revealed perceived declines in physical, cognitive, and mental health of ADC users and increased caregiver strain. Access to human, social, economic, and political capital were essential for supporting ADCs in buffering the impacts of the pandemic on the older adults they serve but were not consistently available. Research is urgently needed that quantifies the impacts of the pandemic on ADC users and their caregivers to inform policy and advocacy efforts in the wake of the pandemic. [ABSTRACT FROM AUTHOR]

The impact of climate-related disasters such as wildfires on healthcare delivery and cancer care is a growing concern. Patients undergoing radiotherapy are particularly vulnerable to treatment interruptions which are known to have a direct impact on survival outcomes. We report results of the first pilot study characterizing the impact of wildfires on radiation oncology clinics and their patients. A survey was sent to 415 California radiation oncologists representing 144 clinics identified using the ASTRO member directory to gather information about clinic and radiation oncologist demographics, wildfires' impacts on the clinic (physical/operational), physicians, staff, and patients between 2017 and 2022, as well as clinics' disaster preparedness efforts. A total of 51 radiation oncologists completed the survey, representing 43 clinics (30% of clinics) in 24 (41%) of California counties. 35 (69%) of respondents self-identified as male, 27 (53%) worked at hospital-affiliated centers, 19 (37%) worked in academic centers, with 49 (96%) practicing in metropolitan areas. A total of 31 clinics were impacted by a wildfire between 2017 and 2020. The two rural clinics (100%) and 29 (59%) of metro practices reported being impacted by wildfires in the last 5 years, with 9 (18%) reporting a clinic closure and 15 (29%) reporting staffing shortages. 28 (55%) of respondents reported impacts on patients including having to evacuate, 27 (53%) having to cancel or reschedule treatments, and 23 (45%) experiencing physical, mental, or financial hardship due to the wildfires. Among the 25 clinics impacted by wildfires, 12 (24%) reported physical/operational impacts including being forced to evacuate patients to another treatment center, transportation interruptions (19, 37%), community and regional evacuations (18, 35%), school closures (18, 35%), and physical/mental health impacts (14, 27%) on staff due to the wildfires. Small clinics (25 staff or less) that experienced a wildfire were twice as likely to experience closures (6 of 16 clinics, 38%) but equally likely to experience staffing shortages (8 of 16, 50 %) as compared to larger practices (7 of 15, 47%). Nearly half of respondents 25 (47%) reported their workplace had a wildfire emergency preparedness plan. The results of this study demonstrate the significant impact wildfires have on patient care in both rural and metropolitan areas. The findings emphasize the importance of emergency preparedness planning to minimize the consequences of such disasters and underscores the need for further research to explore risk factors associated with patient and community vulnerability to climate-related crises. Such research will be essential to informing and developing future emergency preparedness plans. [ABSTRACT FROM AUTHOR]

Year-to-year extreme alterations in California (CA) precipitation, denoted here as flips, present significant challenges to resource managers, emergency management officials, and the state's economy and ecosystems generally. We evaluate regional (north, central, and south) and statewide flip behavior since 1571 CE utilizing instrumental data and paleoclimate reconstructions. Flips, defined as dry-to-wet and wet-to-dry consecutive alterations between the tailward 30th percentiles of the precipitation distribution, have occurred throughout this period without indication of systematic change through the recent time of modern anthropogenic forcing. Statewide ''grand flips'' are notably absent between 1892 and 1957; bootstrap Monte Carlo analysis indicates that this feature is consistent with random behavior. Composites for northeastern Pacific Ocean winter sea level pressure and jet-stream winds associated with flip events indicate anomalous high or low pressure during the core precipitation delivery season for dry or wet flip years, respectively, and jet-stream conditions that are also like those associated with individual dry or wet years. Equatorial Pacific sea surface temperatures play a partial role in both dry-to-wet and wet-to-dry events in central and southern CA in the longer-period reconstruction data, with response restricted primarily to southern CA in the smaller sample-size instrumental data. Knowledge of a prior year extreme, potentially representing initiation of a flip, provides no enhancement of prediction quality for the second year beyond that achievable from skillful seasonal prediction of equatorial Pacific sea surface temperatures. Overall, results indicate that the first-order nature of flip behavior from the later 1500s reflects the quasi-white noise nature of precipitation variability in CA, influenced secondarily by equatorial Pacific sea surface conditions, particularly in southern CA. [ABSTRACT FROM AUTHOR]

Background: The outbreak of coronavirus disease 2019 (COVID-19) rippled across the world from Wuhan, China, to the shores of the United States within a few months. Hospitals and intensive care units were suddenly faced with a "tsunami" warning requiring instantaneous implementation and escalation of disaster plans. Evidence Review: An evidence-based question was developed and an extensive review of the literature was completed, resulting in a structured plan for the intensive care units to manage a surge of patients critically ill with COVID-19 in March 2020. Twenty-five sources of evidence focusing on pandemic intensive care unit and COVID-19 management laid the foundation for the team to navigate the crisis. Implementation: The Critical Care Services task force adopted recommendations from the CHEST consensus statement on surge capacity principles and other sources, which served as the framework for the organized response. The 4 S's became the focus: space, staff, supplies, and systems. Development of algorithms, workflows, and new processes related to treating patients, staffing shortages, and limited supplies. New intensive care unit staffing solutions were adopted. Evaluation: Using a framework based on the literature reviewed, the Critical Care Services task force controlled the surge of patients with COVID-19 in March through May 2020. Patients received excellent care, and the mortality rate was 0.008%. The intensive care unit team had the needed respiratory and general supplies but had to continually adapt to shortages of personal protective equipment, cleaning products, and some medications. Sustainability: The intensive care unit pandemic response plan has been established and the team is prepared for the next wave of COVID-19. [ABSTRACT FROM AUTHOR]

Wildland firefighters engaged in fire suppression activities are often exposed to hazardous air pollutants such as polycyclic aromatic hydrocarbons (PAHs) and particulate matter (PM2.5) during wildfires with no respiratory protection. Although the most significant exposures to smoke likely occur on the fireline, wildland firefighters may also be exposed at the incident command post (ICP), an area designated for wildfire suppression support operations. Our objective was to characterize exposures of PAHs and PM2.5 near an ICP during a wildfire event in California. We collected area air samples for PAHs and PM2.5, during the first 12 days of a wildfire event. PAH area air samples were actively collected in 12-hr shifts (day and night) using XAD4-coated quartz fiber filters and XAD2 sorbent tubes and analyzed for 17 individual PAHs. Hourly area PM2.5 concentrations were measured with an Environmental Beta Attenuation Monitor. Most PAH concentrations generally had similar concentrations during the day and night. PM2.5 concentrations were higher during the day, due to increased fire activity, than at night. The highest concentrations of the 17 PAHs measured were for naphthalene, phenanthrene, and retene. The location of an ICP may be a critical factor in reducing these potential exposures to firefighters during wildfire events. Additionally, exposures could be reduced by utilizing clean air tents or sleeping trailers with HEPA filtration or setting up smaller camps in less smokey areas closer to the fireline for firefighters. Although measured exposures to PAHs for firefighters from smoke are lower at an ICP, these exposures still contribute to the overall cumulative work exposures. [ABSTRACT FROM AUTHOR]

The California wildfires of 2017 forced one hospital within a multi-hospital system to evacuate. Technology-enabled staffing systems, along with analytics, assisted in maximizing the ability to provide essential services. Lessons learned may assist nurse leaders to prepare for similar situations. [ABSTRACT FROM AUTHOR]

The goal of disaster mitigation, response, and recovery is to ensure the community does not lose healthcare services and the hospital maintains business continuity. The primary goal is to maintain safe patient care and care for all disaster victims who arrive. A secondary goal is to minimize financial impact by utilizing resources efficiently. Maintaining nurse staffing during times of crisis requires planning and a system to mobilize resources, as well as an organized disaster program at the hospital. Two different staffing plans will be presented from two Los Angeles hospitals that are designated by the Los Angeles County Emergency Medical Services Agency as a Disaster Resource Center. [ABSTRACT FROM AUTHOR]

• Assess the seismic reliability analysis of a bridge network using BC approach. • Propose a new computationally efficient BC concept to rank importance order of bridges. • Suggest the seismic retrofit plan of a bridge network based on the BC importance of bridges. • Present a BC-based approach that improves the network performance using new constructions. Although bridges are integral parts of transportation networks, they are vulnerable to natural hazards. The damage incurred during these natural hazards events leads to network disruptions and hinders post-event recovery. Therefore, improving the seismic performance of transportation networks is critical. This paper proposes an origin–destination pair betweenness centrality (BC)-based methodology to rank bridges according to their importance in a complex bridge network. The proposed methodology is an easy-to-use approach that considers user equilibrium and topology and significantly shorten the computational time. In addition, this study proposes two strategies including the retrofit of bridges and construction of new bridges based on the BC importance of bridges to mitigate the seismic risk of bride networks. A well-studied bridge network in California was used to demonstrate the application and the effect of different strategies was compared in this study. Bridges located at the shortest path significantly affect the seismic performance of bridge networks, indicating there is no need to rehabilitate or replace all bridges under budget constraints. Also, constructing five new bridges based on BC importance improved seismic performance of the bridge network much more than retrofitting 21 bridges. Moreover, the proposed methodology presents a significant reduction in computational time (only 1/30 compared with an existing study) in resolving the importance of bridges in a network and can be applied to provide useful information for disaster management teams to mitigate the seismic risk of bridge networks. [ABSTRACT FROM AUTHOR]

Nurses are a vital part of the American Red Cross' disaster response, which includes providing services, relief, and support during emergencies. The work of Red Cross nurses isn't limited to responding to the immediate needs of those in crisis, however. This article describes one nurse's experience supporting a California woman in the days and months after a fire destroyed her home. It demonstrates the complexity of care nurse volunteers provide - often for a sustained period of time — and the many obstacles they help to navigate during recovery. [ABSTRACT FROM AUTHOR]

In emergency management, tools are needed so we can take the appropriate action at different stages of an evacuation. Recent wildfires in California showed how quickly a natural disaster can affect a large geographical area. Natural disasters can create unpredicted traffic congestion or can temporarily block urban or rural roads. Evacuating a large area in an emergency situation is not possible without prior knowledge of the road network and the ability to generate an efficient evacuation plan. An ideal evacuation routing algorithm should be able to generate realistic and efficient routes for each evacuee from the source to the closest shelter. It should also be able to quickly update routes as the road network changes during the evacuation. For example, if a main road is blocked during a flood, the evacuation routing algorithm should update the plan based on this change in the road network. In this article major works in evacuation routing have been studied and a new algorithm is developed that is faster and can generate better evacuation routes. Additionally, it can quickly adjust the routes if changes in the road network are detected. The new algorithm's performance and running time are reported. [ABSTRACT FROM AUTHOR]

A five-year drought in California led to a significant increase in tree mortality in the Sierra Nevada forests from 2012 to 2016. Landscape level monitoring of forest health and tree dieback is critical for vegetation and disaster management strategies. We examined the capability of multispectral imagery from the Moderate Resolution Imaging Spectroradiometer (MODIS) in detecting and explaining the impacts of the recent severe drought in Sierra Nevada forests. Remote sensing metrics were developed to represent baseline forest health conditions and drought stress using time series of MODIS vegetation indices (VIs) and a water index. We used Random Forest algorithms, trained with forest aerial detection surveys data, to detect tree mortality based on the remote sensing metrics and topographical variables. Map estimates of tree mortality demonstrated that our two-stage Random Forest models were capable of detecting the spatial patterns and severity of tree mortality, with an overall producer's accuracy of 96.3% for the classification Random Forest (CRF) and a RMSE of 7.19 dead trees per acre for the regression Random Forest (RRF). The overall omission errors of the CRF ranged from 19% for the severe mortality class to 27% for the low mortality class. Interpretations of the models revealed that forests with higher productivity preceding the onset of drought were more vulnerable to drought stress and, consequently, more likely to experience tree mortality. This method highlights the importance of incorporating baseline forest health data and measurements of drought stress in understanding forest response to severe drought. [ABSTRACT FROM AUTHOR]

This study considers the statistics of fluid-induced and remotely triggered seismicity at The Geysers geothermal field, California. Little seismicity was reported before steam extraction began in 1960. Beginning in 1980 the residual water associated with power generation was re-injected, producing induced seismicity. Beginning in 1997 large-scale injections of cold water began to enhance the generation of steam. This led to an increase in M < 1.2 earthquakes from approximately 5 per month to 20. Two excellent seismic networks generate two earthquake catalogs for the fluid-induced seismicity at The Geysers. Although this seismicity satisfies Gutenberg-Richter (GR) scaling to a good approximation, the scaling parameters differ. We propose a correction that eliminates this problem. We show that the seismicity at The Geysers is nearly independent of time for the period 2009-2014 and suggest that this supports our hypothesis that the seismic moment release is in near balance with the geodetic moment accumulation in the region. Our study demonstrates that aftershocks of the larger fluid-induced earthquakes also satisfy GR scaling as well as Omori's law for their time dependence. Our results support the hypothesis that the earthquakes are caused by the reduction in friction on faults due to the injected fluids. Statistics of remotely triggered earthquakes and their associated aftershocks at The Geysers are also presented. The 8/24/14 M = 6.02 South Napa earthquake triggered an M ≈ 4.38 event as well as some 80 other M > 1.25 events. The GR and decay statistics are given. However, to separate aftershocks from remotely triggered earthquakes, an additional triggered sequence is studied. The M = 7.2 4/4/10 Baja earthquake triggered some 34 M > 1.25 earthquakes at The Geysers in the first hour including an M = 3.37 event. We conclude that the remotely triggered seismicity is dominated by local aftershocks of the larger remotely triggered earthquakes. [ABSTRACT FROM AUTHOR]

The article discusses what the authors refer to as the benefits associated with making climate change the focus of U.S. public health policy as of 2017, and it mentions the Intergovernmental Panel on Climate Change (IPCC) and the impact of climate change on human health. Disaster preparedness and clean fuel technologies are examined, along with executive orders, greenhouse gas mitigation policies, and affordable housing in places such as California.

This paper examines the relationship between collaborative disaster mapping and conceptions of risk. It looks at the practice of mapmaking during the 2007 wildfires in Southern California to explore sociotechnological issues in creating a shared understanding. By comparing and contrasting how two different, yet intertwined, maps were made this paper focuses on how the sociotechnical acts of alignment necessary for the production of the maps change how risk, threat and uncertainty are approached. One mapmaking practice pulled the actors into a more centralized alignment producing risks related to managing authority and security. The other provided a more distributed collaboration and produced risks related to public trust and consistency. This paper argues that mapmaking is characterized as a messy, distributed network of knowledge production in which the meaning of risk emerges through the collaborations that evolve in making sense of the wildfires, not as an a priori definition. [ABSTRACT FROM AUTHOR]

Purpose: The evaluation aims to assess emergency preparedness (EP) among Native American tribes in California to inform future development of priorities and strategies for improvement. The analysis explores funding barriers and gaps in resource availability. Methods: A cross-sectional survey was designed to explore four aspects of EP: 1) perceptions of preparedness; 2) funding mechanisms; 3) resource availability; and 4) plans for future preparedness efforts. The survey was conducted online, by telephone, fax, or mail. Analysis includes National Incident Management System (NIMS) and Standardized Emergency Management System (SEMS) compliance, and Federal Emergency Management Agency (FEMA) approval of disaster mitigation plans. Results and Discussion: Findings represent 40% of the federally-recognized California tribes. Participants included: tribal chairpersons and administrators, emergency services managers, fire chiefs, police chiefs, and environmental directors. Results indicated low awareness of funding regulations and instructional opportunities yet high interest; high dependency on external EP response resources; and needed improvements in community involvement. Conclusion: Partnerships with local emergency preparedness and academic organizations and improved communication are recommended to bridge gaps in resources and awareness. This evaluation provides one of the first systematic assessments of EP achievements and gaps among Native American tribes in California. Future studies are needed to explore these preliminary findings. [ABSTRACT FROM AUTHOR]

This research note summarizes observed similarities, differences, and mixed similarities and differences between emergency responders in California's emergency response infrastructure and control room operators in some other critical infrastructures there. The dissimilarities are all the more striking given the many similarities. The chief difference, we speculate, lies in the conditions on and skills of control room operators to ensure the continuous and safe provision of the critical service in question, even during (especially during) turbulent times - what we have called 'high reliability management'. This management differs considerably from the active crisis management of many emergency responders, although both groups seek to manage 'reliably'. [ABSTRACT FROM AUTHOR]

Legal protections granted to disabled individuals remain in place during emergencies. This article considers lawsuits brought against Los Angeles and New York concerning their treatment of disabled individuals within their emergency plans, explores how the principle of justice supports these rulings, and discusses lessons learned for other localities. [ABSTRACT FROM AUTHOR]

Objective. We tested the Analytical Hierarchy Process tool for its use in public health to identify potential gaps in emergency preparedness by local health departments (LHDs) in California and Hawaii during a radiological emergency. Methods. We developed a dedicated tool called All-Hazards Preparedness Squared (AHP2) that can be used by those who are responsible for all-hazards preparedness planning and response to guide them while making strategic decisions both in preparing for and responding to a slow-moving incident while it is unfolding. The tool is an Internet-based survey that can be distributed among teams responsible for emergency preparedness and response. Twenty-eight participants from 16 LHDs in California and Hawaii responsible for coordinating preparedness and response in a radiological emergency participated in using the tool in 2013. We used the data to compare the perceived importance of different elements of preparedness among participants and identify gaps in preparedness of their organizations for meeting the challenges presented by a radiological incident. Results. Clarity of information and transfer of information (to and from agency to public, state, and federal partners) were public health officials’ dominant concerns while responding to an emergency. Participants also found that there were gaps in the adequacy of training and awareness of the chain of command during a radiological emergency. Conclusion. This preliminary study indicates that the AHP2 tool could be used for decision making in all-hazards preparedness planning and response. [ABSTRACT FROM AUTHOR]

Rapid post-earthquake damage diagnosis of bridges can guide decision-making for emergency response management and recovery. This can be facilitated using digital technologies to remove the barriers of manual post-event inspections. Prior mechanics-based Finite Element (FE) models can be used for post-event response simulation using the measured ground motions at nearby stations; however, the damage assessment outcomes would suffer from uncertainties in structural and soil material properties, input excitations, etc. For instrumented bridges, these uncertainties can be reduced by integrating sensory data with prior models through a model updating approach. This study presents a sequential Bayesian model updating technique, through which a linear/nonlinear FE model, including soil-structure interaction effects, and the foundation input motions are jointly identified from measured acceleration responses. The efficacy of the presented model updating technique is first examined through a numerical verification study. Then, seismic data recorded from the San Rogue Canyon Bridge in California are used for a real-world case study. Comparison between the free-field and the foundation input motions reveals valuable information regarding the soil-structure interaction effects at the bridge site. Moreover, the reasonable agreement between the recorded and estimated bridge responses shows the potentials of the presented model updating technique for real-world applications. The described process is a practice of digital twinning and the updated FE model is considered as the digital twin of the bridge and can be used to analyze the bridge and monitor the structural response at element, section, and fiber levels to diagnose the location and severity of any potential damage mechanism. [ABSTRACT FROM AUTHOR]

This article explores the materiality of disaster politics through the practice of mapping during the 2007 wildfires in Southern California. It examines the process of production of two different maps, the maps produced by San Diego County and a popular Google My Map created by local media and academic institutions, in order to explore how an unfolding disaster comes to be understood. This article argues that the interplay between different technological and human entities to produce each map in turn produced different spaces of disaster in ways that challenged priorities of disaster preparedness and response. Specifically, the different mapping practices in 2007 produced different relationships to temporality, boundaries and responsibility, making different aspects of the disaster visible while constructing different threats and definitions of danger. They juxtaposed representational and relational knowledge as well as the value of prevention and demonstration. This article draws on data collected through textual analysis of government and scientific documents as well as interviews and observations of key actors, their mapping practices, and socio-technological networks. [ABSTRACT FROM AUTHOR]