Journal articles on the topic 'Disaster medicine – United States – Planning'

International organizations such as the World Association for Emergency and Disaster Medicine (Club of Mainz) have brought attention to the need for improved worldwide emergency medical services (EMS) systems and disaster preparedness (1). Similar concerns in the United States (US) for improved emergency medical care have resulted in the organization of emergency medicine as a new medical specialty (2). The practice of this specialty of medicine in some ways differs from the practice of emergency medicine, reanimation medicine, or resuscitology, in Europe. In the United States, emergency medicine specialists provide emergency care for the full range of emergency health conditions, including accidents and trauma, medical emergencies, toxicologic emergencies, psychiatric and social emergencies, and disasters. This care is provided primarily in hospital emergency departments and includes the immediate initial recognition, evaluation, treatment and disposition of these patients with acute illness and injury. For continuing care, patients are referred to their own physicians.Emergency medicine physicians provide medical direction for community EMS and supervise the prehospital emergency medical care provided by non-physicians (emergency medical technicians and paramedics). Emergency physicians engage in the administration, research and teaching of all aspects of emergency medical care. They also provide consultation to governmental and nongovernmental organizations on emergency health care issues. Recently, with the basic framework of emergency medicine established, attention is being given to disaster planning and management.

AbstractObjectives:Disaster Medicine (DM) education for Emergency Medicine (EM) residents is highly variable due to time constraints, competing priorities, and program expertise. The investigators’ aim was to define and prioritize DM core competencies for EM residency programs through consensus opinion of experts and EM professional organization representatives.Methods:Investigators utilized a modified Delphi methodology to generate a recommended, prioritized core curriculum of 40 DM educational topics for EM residencies.Results:The DM topics recommended and outlined for inclusion in EM residency training included: patient triage in disasters, surge capacity, introduction to disaster nomenclature, blast injuries, hospital disaster mitigation, preparedness, planning and response, hospital response to chemical mass-casualty incident (MCI), decontamination indications and issues, trauma MCI, disaster exercises and training, biological agents, personal protective equipment, and hospital response to radiation MCI.Conclusions:This expert-consensus-driven, prioritized ranking of DM topics may serve as the core curriculum for US EM residency programs.

The 1973 Emergency Medical Services System Act in the United States mandates that one of the 15 functions to be performed by every EMS system is coordinated disaster planning. Implicit in the legislation is the assumption that everyday emergency medical service (EMS) systems will be the basis for the provisions of EMS in extraordinary mass emergencies, or in the language of the act, during “mass casualties, natural disasters or national emergencies.” Policy interpretations of the Act specified that the EMS system must have links to local, regional and state disaster plans and must participate in biannual disaster plan exercises. Thus, the newly established EMS systems have been faced with both planning for, as well as providing services in large-scale disasters.

As evidenced in a number of recent disasters, there appears to be an increasing trend, for health care professionals to leave the confines of the hospital to provide on-scene care. This trend may be due to a number of recommendations from a variety of sources such as the National Disaster Medical System, the implementation of the United States Military Disaster Response, Federal Aviation Administration (FAA) recommended airport disaster plans, trends in community disaster planning, and Emergency Medical Services practice.

Introduction:More than 14 million children in the United States attend summer camps yearly, including many special medical needs children. Summer camps are at risk for multiple pediatric casualties during a disaster. The American Camp Association, in the 2017 critical issues report, identified emergency preparedness as the top critical health and safety issue. Camps, compared to school-based settings, face unique challenges when planning for disasters, but research has been challenging because of the lack of access to camp leadership and data.Aim:Provide a targeted up-to-date synopsis on the current state of disaster preparedness and ongoing collaborative research and technology interventions for improving preparedness among summer camps.Methods:Researchers partnered with a national health records system (CampDoc.com) and American Academy of Pediatrics disaster experts to review results from a national camp survey. Main themes were identified to assess gaps and develop strategies for improving disaster preparedness.Results:169 camps responses were received from national camp leadership. A substantial proportion of camps were missing 4 critical areas of disaster planning: 1) Most lacked online emergency plans (53%), methods to communicate information to parents (25%), or strategies to identify children for evacuation/reunification (40%); 2) Disaster plans failed to account for special/medical needs children (38%); 3) Staff training rates were low for weather (58%), evacuation (46%), and lockdown (36%); 4) Most camps (75%) did not plan with disaster organizations.Discussion:Collaboration with industry and disaster experts will be key to address the gaps identified. Current research and interventions include the recent release of a communication alert tool allowing camps to send mass text emergency notifications. Additionally, a recent pilot to incorporate disaster plans into the electronic health records platform emphasizing communication, evacuation, and identification of local experts has begun. Efforts to develop a unified disaster tool kit for summer camps remains a challenge.

AbstractHomelessness is a growing problem, with perhaps greater than a 150 million homeless people globally. The global community has prioritized the problem, as eradicating homelessness is one of the United Nation’s sustainability goals of 2030. Homelessness is a variable entity with individual, population, cultural, and regional characteristics complicating emergency preparedness. Overall, there are many factors that make homeless individuals and populations more vulnerable to disasters. These include, but are not limited to: shelter concerns, transportation, acute and chronic financial and material resource constraints, mental and physical health concerns, violence, and substance abuse. As such, homeless population classification as a special or vulnerable population with regard to disaster planning is well-accepted. Much work has been done regarding best practices of accounting for and accommodating special populations in all aspects of disaster management. Utilizing what is understood of homeless populations and emergency management for special populations, a review of disaster planning with recommendations for communities was conducted. Much of the literature on this subject generates from urban homeless in the United States, but it is assumed that some lessons learned and guidance will be translatable to other communities and settings.

The world population is becoming increasingly reliant upon nuclear fission for the generation of electric power. In the wake of this activity, there have been two major accidents: Three Mile Island (TMI), near Harrisburg, Pennsylvania, United States, in 1979; and Chernobyl, near Kiev, Ukraine, Soviet Union, in 1986. It is noteworthy that both of these accidents were related to human error and not to malfunction of the emergency back-up systems. So far, nuclear energy production plant accidents have occurred when either the data were misinterpreted or systems misguided by human function.The major problem associated with a nuclear energy generating plant accident is the release of radiation. Even though the medical facilities may not be destroyed physically, they may be rendered useless because of contamination by radiation. Unfortunately, in the event of such an accidental release of radiation, all of the health-care facilities in the area will be contaminated. Therefore, all patients in hospitals and nursing homes will need to be evacuated to facilities outside of the contaminated area and not just relocated within the contaminated area.

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

Objective: Describe institutional disaster preparations focusing upon the strategies to address pediatric patients in disaster preparedness.Design: Descriptive study using survey methodology.Setting: Hospitals that provide emergency care to pediatric patients throughout the United States.Participants: Survey responses were solicited from hospital personnel that are familiar with the disaster preparedness plan at their institution.Interventions: None.Main outcome measures: Describe how pediatric patients are included in institutional disaster preparedness plans. The presence of a pediatric-specific lead, policies and procedures, and geographic/demographic patterns are also a focus.Results: The survey was distributed to 120 hospitals throughout the United States and responses were received from 29 states. Overall response rate was 58 percent, with 53 percent of the surveys fully completed. Sixty-three percent of hospitals had an individual responsible for pediatric-specific disaster planning and 78 percent specifically addressed the care of pediatric patients (16 yo) in their disaster plan. The hospitals with an individual designated for pediatric disaster planning were more likely to have a disaster plan that specifically addresses the care of pediatric patients (90 percent vs 56 percent; p = 0.015), to represent children with special healthcare needs as simulated patients in disaster exercises (73 percent vs 22 percent; p = 0.003), and to include pediatric decontamination procedures in disaster exercises (78 percent vs 35 percent; p = 0.008) than hospitals without a designated pediatric disaster planner.Conclusion: The majority of hospitals surveyed incorporate pediatric patients into their disaster preparedness plan. Those hospitals with an individual designated for pediatric disaster planning were more likely to specifically address the care of pediatric patients in their institutional disaster plan.

A disaster may result from a serious or sudden catastrophic event that has the potential for massive loss of infrastructure and significant mortality and morbidity. Disasters may be caused by natural or man-made events. With either type, the forces of the event overwhelm the first responders and health organizations in the stricken community and outside assistance is required. Developing countries have the highest burden with limited available resources. Today's complex disasters have increased the need for mobile medical/surgical response teams to provide disaster care. The United States (US) Government created the International Medical Surgical Response Teams (IMSuRT), which, on short notice, deploy a multidisciplinary team of doctors, nurses, and other health professionals to disasters around the world. IMSuRT has a rapidly deployable, fully equipped field hospital. Historically, Massachusetts General Hospital (MGH) in Boston, Massachusetts, US, has played a significant role in responding to humanitarian efforts both within the US and internationally. The MGH nurses play key roles in several response teams, including IMSuRT. Disaster nursing has many unique challenges. Nurses practice daily under controlled situations and become expert in one specialty; however, in the disaster setting this is not possible. Disaster nursing requires a fundamental change in the care of patients. During disasters, nurses work in areas that are not their primary specialty. Disaster nurses must be prepared in the essentials of disaster response- this requires planning, preparation, and training with multiple simulation drills focusing on patient scenarios, equipment utilization, teamwork, triage, decontamination, and scene safety. We must be creative, adaptable, and flexible to the needs of the disaster. Most importantly, cultural sensitivity, and communication are important factors in the delivery of disaster care.

As governments grapple with increased risks associated with more frequent and impactful disasters, climate change, social inequity, urbanization, and aging infrastructure, questions about resilience take on greater urgency. The US National Academies of Sciences, Engineering, and Medicine strive for science to be beneficial to society. In 2012, the National Academies released a report, Disaster Resilience: A National Imperative, that provided recommendations around critical issues of resilience and strategic steps the United States could take towards building disaster resilience. A new program, the Resilient America Program, was created as an outgrowth of that report. Its core mission is to partner with communities across the nation to help decision-makers identify key priorities for their community; tie those priorities to relevant risks; and identify actions that build resilience to those risks. The Resilient America Program is a novel program of the National Academies; it employs a hands-on approach to bring science into decision-making by working directly with decision-makers to test approaches for communicating and managing risk, measuring resilience, building community partnerships, and sharing relevant resilience information.

AbstractIntroductionAs attention to emergency preparedness becomes a critical element of health care facility operations planning, efforts to recognize and integrate the needs of vulnerable populations in a comprehensive manner have lagged. This not only results in decreased levels of equitable service, but also affects the functioning of the health care system in disasters. While this report emphasizes the United States context, the concepts and approaches apply beyond this setting.ObjectiveThis report: (1) describes a conceptual framework that provides a model for the inclusion of vulnerable populations into integrated health care and public health preparedness; and (2) applies this model to a pilot study.MethodsThe framework is derived from literature, hospital regulatory policy, and health care standards, laying out the communication and relational interfaces that must occur at the systems, organizational, and community levels for a successful multi-level health care systems response that is inclusive of diverse populations explicitly. The pilot study illustrates the application of key elements of the framework, using a four-pronged approach that incorporates both quantitative and qualitative methods for deriving information that can inform hospital and health facility preparedness planning.ConclusionsThe conceptual framework and model, applied to a pilot project, guide expanded work that ultimately can result in methodologically robust approaches to comprehensively incorporating vulnerable populations into the fabric of hospital disaster preparedness at levels from local to national, thus supporting best practices for a community resilience approach to disaster preparedness.KreisbergD, ThomasDSK, ValleyM, NewellS, JanesE, LittleC. Vulnerable populations in hospital and health care emergency preparedness planning: a comprehensive framework for inclusion. Prehosp Disaster Med. 2016;31(2):211–219.

Law plays a critical role in all stages of a public health emergency, including planning, response, and recovery. Public health emergencies introduce health concerns at the population level through, for example, the emergence of a novel infectious disease. In the United States, at the federal, state, and local levels, laws provide an infrastructure for public health emergency preparedness and response efforts: they grant the government the ability to officially declare an emergency, authorize responders to act, and facilitate interjurisdictional coordination. Law is perhaps most visible during an emergency when the president or a state's governor issues a disaster declaration establishing the temporal and geographic parameters for the response and making financial and other resources available. This legal authority has increasingly been used during the last decade.

Although older people may be recognized as a vulnerable group post-natural disasters, their particular needs are rarely met by the providers of emergency services. Studies about older people’s health needs post disasters in the South East Asia Tsunami, Kashmir, Pakistan, China, and United States has revealed the lack of concern for older people’s health needs. Recent study of older people’s health needs post the Kashmir Pakistan earthquake (2005) found older peoples’ health needs were masked within the general population.This survey study examines the providers’ perceptions of older people’s vulnerabilities post-2005 Pakistan earthquake. It aims to understand the awareness of geriatric issues and issues related to current service provision/planning for older people’s health needs post disasters. Specifically, service delivery patterns will be compared among different relief agencies.Cross-sectional, structured stakeholder interviews were conducted within a 2 weeks period in February 2006, 4 months post-earthquake in Pakistan-administrated Kashmir. Health/medical relief agencies of three different types of organizational nature: international nongovernmental organization (INGO), national organization, and local/community group were solicited to participate in the study. Descriptive analysis was conducted.Important issues identified include the need to sensitize relief and health workers about older people’s health needs post disaster, the development of relevant clinical guidelines for chronic disease management postdisaster in developing countries and the advocacy of building in geriatric related components in natural disaster medical relief programs.To effectively address the vulnerability of older people, it is important for governments, relief agencies, and local partners to include and address these issues during their relief operations and policy planning.

IntroductionHistory is replete with interoperability and resource reporting deficits during disaster that impact medical response and planning. Situational awareness for disaster and emergency medical response includes communicating health hazards as well as infrastructure and resource status, capability and GIS location. The need for actionable, real-time data is crucial to response. Awareness facilitates medical resource placement, response and recovery. A number of internet, web-based disaster resource and situational status reporting applications exist but may be limited or restricted by functional, jurisdictional, proprietary and/or financial requirements. Restrictions prohibit interoperability and inhibit information sharing that could affect health care delivery. Today multiple United States jurisdictions are engaged in infrastructure and resource situation status reporting via “virtual” states and regional projects considered components of “Virtual USA”.MethodsThis report introduces the United States' Department of Homeland Security's “Virtual USA” initiative and demonstrates a health application and interoperability via “Virtual Louisiana's” oil spill related exposure reporting during the 2010, British Petroleum Gulf Horizon catastrophe. Five weekly Louisiana Department of Health and Hospital summary reports from the Louisiana Poison Center; Hospital Surveillance Systems; Public Health Hotline; and Physician Clinic Offices were posted on the Louisiana Office of Homeland Security and Emergency Preparedness's “Virtual Louisiana”.Results227 total spill-related, exposure cases from five reporting weeks were provided by five Louisiana source agencies and reported in Virtual Louisiana. Cases were reported weekly and classified as “workers” or “population”; associated with the parish exposure locations (8), offshore (1), or unknown (1); and shared with four other virtual states.ConclusionsReal-time health and medical situation status, resource awareness, and incident impact could be facilitated through constructs demonstrated by “Virtual USA”.

AbstractThe Hospital Surge Preparedness and Response Index is an all-hazards template developed by a group of emergency management and disaster medicine experts from the United States. The objective of the Hospital Surge Preparedness and Response Index is to improve planning by linking action items to institutional triggers across the surge capacity continuum. This responder tool is a non-exhaustive, high-level template: administrators should tailor these elements to their individual institutional protocols and constraints for optimal efficiency. The Hospital Surge Preparedness and Response Index can be used to provide administrators with a snapshot of their facility’s current service capacity in order to promote efficiency and situational awareness both internally and among regional partners.

Training for disaster responsiveness for veterinarians includes Incident Command System (ICS) and National Incident Management System (NIMS) comprehension, euthanasia, bio-security, all-hazards emergency preparedness, business continuity training, responder training, and incident de-briefing, Public and emergency management officials at all levels agree that saving animal lives saves human lives. Despite the recognition of the importance of veterinarians and other animal caretakers in animal disaster response and incident de-briefing, there has been less than adequate targeting of these groups for training opportunities leaving many veterinarians and other animal care takers vulnerable and unsure of their role when presented with a call to action in the midst of a disaster scenario in their home communities. The Louisiana State University School of Veterinary Medicine (LSU-SVM) has taken advantage of its physical presence amidst a disaster prone region of the United States to form response teams made up of students, faculty, and staff for actual training events termed disaster response experiential learning. Through a solid partnership with the Louisiana State Animal Response Team (LSART) and other response groups, the LSU-SVM has developed a disaster response program that includes animal response planning, evacuation, sheltering, emergency triage, and technical rescue expertise. Five specific response activities that occurred between 2001 and 2010 where LSU-SVM partnered with local and regional emergency responders enabled veterinary students and veterinarians to provide the work force and engage in experiential learning in a “hand-over-hand” environment with certified emergency responders. The response activities and partnerships demonstrate a successful model for veterinary student and veterinarian training in disaster response, have provided robust training experiences for hundreds of veterinary students and veterinarians, and have resulted in the subsequent development of courses to address identified gaps in veterinary disaster response training.

In view of public concern about health impairment from accidental radiation exposure, the record of forty years experience in the utilization of nuclear energy was reviewed. All reported exposure incidents producing health effects from external radiation sources and internal radionuclide contamination in the United States and some in other countries have been included. Preparations for the management of such accidents will be considered briefly. The relationship of this actual accident experience to the unresolved problems in management planning and professional and public education for future accidents like that at the Three Mile Island nuclear power station in Middletown, Pennsylvania, March 1979, but with potential associated health impairment, was discussed. The complete paper is published in the Proceedings of the 3rd World Congress for Emergency and Disaster Medicine, organized by the “Club of Mainz” in Rome, Italy, 1983 (see Manni, C and Magalini, S, Springer Publ, Heidelberg, 1984).

AbstractIntroduction:In 2009, the Institute of Medicine published guidelines for implementation of Crisis Standards of Care (CSC) at the state level in the United States (US). Based in part on the then concern for H1N1 pandemic, there was a recognized need for additional planning at the state level to maintain health system preparedness and conventional care standards when available resources become scarce. Despite the availability of this framework, in the years since and despite repeated large-scale domestic events, implementation remains mixed.Problem:Coronavirus disease 2019 (COVID-19) rejuvenates concern for how health systems can maintain quality care when faced with unrelenting burden. This study seeks to outline which states in the US have developed CSC and which areas of care have thus far been addressed.Methods:An online search was conducted for all 50 states in 2015 and again in 2020. For states without CSC plans online, state officials were contacted by email and phone. Public protocols were reviewed to assess for operational implementation capabilities, specifically highlighting guidance on ventilator use, burn management, sequential organ failure assessment (SOFA) score, pediatric standards, and reliance on influenza planning.Results:Thirty-six states in the US were actively developing (17) or had already developed (19) official CSC guidance. Fourteen states had no publicly acknowledged effort. Eleven of the 17 public plans had updated within five years, with a majority addressing ventilator usage (16/17), influenza planning (14/17), and pediatric care (15/17), but substantially fewer addressing care for burn patients (9/17).Conclusion:Many states lacked publicly available guidance on maintaining standards of care during disasters, and many states with specific care guidelines had not sufficiently addressed the full spectrum of hazard to which their health care systems remain vulnerable.

IntroductionIn emergency preparedness there is the need to prospectively develop an approach to which interventions can be provided with available resources and the maximal amount of clinical effectiveness which can be attained by staff.MethodsA panel of pediatric emergency preparedness experts employed our previously validated evidence based consensus process with a modified Delphi process for topic selection and approval. Interventions were chosen such that resources and staff efficiency would not exceed previously published data for non-disaster emergency care but allowing for standard emergency preparedness planning alterations in standards of care such as the assumption that usual numbers of staff would care for a disaster surge of four times the usual number of patients.ResultsUsing standard emergency preparedness assumptions of limited resources and staff efficiency, the panel agreed upon both methodologies for resource allocation and feasible interventions. A number of standard interventions would not be feasible and included detailed recording of vital signs, administration of vasoactive agents, prolonged resuscitation and central venous access.ConclusionBy employing this approach to resource utilization described combined with the unique aspects of pediatric care, we can improve our planning and responses. This can be accomplished by understanding the needs of the population being served, learning how to focus on both pediatric needs and the expectations of the community with regard to care of children, adopting what has been learned in prior events in the United States and abroad, and developing prospective recommendations regarding essential interventions which can be performed in a disaster.

AbstractThe Republic of China on the island of Taiwan has experienced at least 20 terrorist events since 1979, including 13 aircraft hijackings and five bombings. Factors responsible for the relatively small burden of terrorism on Taiwan in the past include tight military control over political dissent until 1987, a warming relationship with the People's Republic of China in the 1990s, political inclusion of major internal cultural groups, geographic isolation, and a lack of other significant international enemies. Nevertheless, today Taiwan faces a new prospect of terrorism by adversaries of the United States and its allies and by an international paradigm shift in the types of weapons used by terrorists.National emergency management has been enhanced significantly since the Ji Ji earthquake in 1999, including the assignment of lead government agencies to the planning and preparedness for specific types of terrorist events involving nuclear, biological, and/or chemical releases. Other significant improvements at the operations level, include the establishment of two national disaster medical assistance teams, four urban search and rescue teams, 13 local disaster medical assistance teams, and eight chemical emergency response hospitals. Future challenges include improving the coordination of inter-agency response at the national level and the quantity and quality of local disaster response assets.

AbstractObjective:Seattle-King County (SKC) Washington is at risk for regional disasters, especially earthquakes. Of 1.8 million residents, >400,000 (22%) are children, a proportion similar to that of the population of the State of Washington (24%) and of the United States (24%). The county's large area of 2,134 square miles (5,527 km2) is connected through major transportation routes that cross numerous waterways; sub-county zones may become isolated in the wake of a major earthquake. Therefore, each of SKC's three sub-county emergency response zones must have ample pediatric medical response capabilities. To date, total quantities and distribution of crucial hospital resources (available in SKC) to manage pediatric victims of a medical disaster are unknown. This study assessed whether geographical distribution of hospital pediatric resources corresponds to the pediatric population distribution in SKC.Methods:Surveys were delivered electronically to all eight acute care hospitals in SKC that admit pediatric patients. Quantities and categories of pediatric resources, including inpatient treatment space, staff, and equipment, were queried and verified via site visits.Results:Within the seven responding hospitals of eight queried, the following were identified: 477 formal pediatric bed spaces (pediatric intensive care unit, neo-natal intensive care unit, general wards, and emergency department), 43 informal pediatric bed spaces (operating room and post-anesthesia care unit), 1,217 pediatric nurses, 554 pediatric physicians, and 252 infant/pediatric-adaptable ventilators. The City of Seattle emergency response zone contains 82.1% of bed spaces, 83.5% of nurses, and 95.8% of physicians, yet only 22.8% of all SKC children live in that zone.Conclusions:The majority of hospital pediatric resources are located in the SKC sub-region with the fewest children. These resources are potentially inaccessible and unable to be redistributed by ground transportation in the event of a significant regional disaster. Future planning for pediatric care in the event of a medical disaster in SKC must address this vulnerability.

Objective: The Institute of Medicine has issued two reports over the past 10 years raising concerns about the care of children in the emergency medical care system of the United States. Given that children are involved in most mass casualty events and there are deficiencies in the day-to-day emergency care of children, this project was undertaken to document the preparedness of hospitals in AR for the care of children in mass casualty or disaster situations.Design: Mailed survey to all emergency department medical directors in AR. Nonresponders received a second mailed survey and an attempt at survey via phone.Participants: Medical directors of the emergency departments of the 80 acute care hospitals in AR.Results: Seventy-two of 80 directors responded (90 percent response rate). Only 13 percent of hospitals reported they have pediatric mass casualty protocols and in only 28 percent of hospitals the disaster plan includes pediatric-specific issues such as parental reunification. Most hospitals hold mass casualty training events (94 percent), at least annually, but only 64 percent report including pediatric patients in their disaster drills. Most hospitals include local fire (90 percent), police (82 percent), and emergency medical services (77 percent) in their drills, but only 23 percent report involving local schools in the disaster planning process. Eighty-three percent of hospitals responding reported their staff is trained in decontamination procedures.Thirty-five percent reported having warm water showers available for infant/children decontamination. Ninety-four percent of hospitals have a plan for calling in extra staff in a disaster situation, which most commonly involves a phone tree (43 percent). Ninety-three percent reported the availability of Ham Radios, walkie-talkie, or Arkansas Wireless Information Network (AWIN) units for communication in case of land line loss, but only 16 percent reported satellite phone or Tandberg units. Twelve percent reported reliance on cell phones in this situation.Conclusions: This survey demonstrated important deficiencies in the preparedness of hospitals in AR for the care of children in disaster. Although many hospitals are relatively well prepared for the care of adults in disaster situations, the needs of children are different and hospitals in AR are not as well prepared for pediatric disaster care.

AbstractIntroductionFormula One returned to the United States on November 16-18, 2012, with the inaugural United States Grand Prix in Austin, Texas. Medical preparedness for motorsports events represents a unique challenge due to the potential for a high number of spectators seeking medical attention, and the possibility for a mass-casualty situation. Adequate preparation requires close collaboration across public safety agencies and hospital networks to minimize impact on Emergency Medical Services (EMS) resources.Hypothesis/ProblemTo report the details of preparation for an inaugural mass-gathering motorsports event, and to describe the details of the medical care rendered during the 3-day event.MethodsA retrospective analysis was completed utilizing postevent summaries, provided by the medical planning committee, by the Federation Internationale de L'Automobile (FIA), and Austin Travis County Emergency Medical Services (ATCEMS). Patient data were collected from standardized patient care records for descriptive analysis. Medical usage rates (MURs) are reported as a rate of patients per 10,000 (PPTT) participants.ResultsA total of 566 patients received medical care over the 3-day period with the on-site care rate of 95%. Overall, MUR was 21.3 PPTT attendees. Most patients had minor problems, and there were no driver injuries or deaths.ConclusionThis mass-gathering motorsport event had a moderate number of patients requiring medical attention. The preparedness plan was implemented successfully with minimal impact on EMS resources and local medical facilities. This medical preparedness plan may serve as a model to other cities preparing for an inaugural motorsports event.SabraJP, CabañasJG, BedollaJ, BorgmannS, HawleyJ, CravenK, BrownC, ZiebellC, OlveyS. Medical support at a large-scale motorsports mass-gathering event: the inaugural Formula One United States Grand Prix in Austin, Texas. Prehosp Disaster Med. 2014;29(4):1-7.

AbstractAs health care systems in the United States have become pressured to provide greater value, they have embraced the adoption of innovative population health solutions. One of these initiatives utilizes prehospital personnel in the community as an extension of the traditional health care system. These programs have been labeled as Community Paramedicine (CP) and Mobile Integrated Health (MIH). While variation exists amongst these programs, generally efforts are targeted at individuals with high rates of health care utilization. By assisting with chronic disease management and addressing the social determinants of health care, these programs have been effective in decreasing Emergency Medical Services (EMS) utilization, emergency department visits, and hospital admissions for enrolled patients.The actual training, roles, and structure of these programs vary according to state oversight and community needs, and while numerous reports describe the novel role these teams play in population health, their utilization during a disaster response has not been previously described. This report describes a major flooding event in October 2015 in Columbia, South Carolina (USA). While typical disaster mitigation and response efforts were employed, it became clear during the response that the MIH providers were well-equipped to assist with unique patient and public health needs. Given their already well-established connections with various community health providers and social assistance resources, the MIH team was able to reconnect patients with lost medications and durable medical equipment, connect patients with alternative housing options, and arrange access to outpatient resources for management of chronic illness.Mobile integrated health teams are a potentially effective resource in a disaster response, given their connections with a variety of community resources along with a unique combination of training in both disease management and social determinants of health. As roles for these providers are more clearly defined and training curricula become more developed, there appears to be a unique role for these providers in mitigating morbidity and decreasing costs in the post-disaster response. Training in basic disaster response needs should be incorporated into the curricula and community disaster planning should identify how these providers may be able to benefit their local communities.Gainey CE, Brown HA, Gerard WC. Utilization of mobile integrated health providers during a flood disaster in South Carolina (USA). Prehosp Disaster Med. 2018;33(4):432–435

Introduction: A burn disaster is defined by a mass casualty involving a large number of severely burned victims. Several countries have been confronted with these mass casualties and have developed national burn practice guidelines. This study presents a comprehensive review of the literature related to the benefits and conditions required for the introduction of a burn plan and identify successful strategies in Europe to apply in Portugal.Methods: This study uses a scoping review approach, following the “five stages framework” suggested by Arksey and O’Malley (2005). A literature search strategy was designed to identify the relevant publications from three medical databases (PubMed/ Medline, ScienceDirect, Scopus). Studies meeting our inclusion criteria were analyzed in detail. Data analysis included a descriptive summary and a thematic analysis.Results: The research revealed that since 2000, 67 articles have been published on the subject. Of these 67 articles, only eight refer to burn plans in Europe. The papers which were included and reviewed were descriptive studies (N = 2), research paper (N = 2), reviews (N = 3), and an editorial (N = 1). Countries with published articles were Switzerland, Sweden, the Netherlands, and the United Kingdom.Conclusions: The research has shown a gap in the planning for major burn disasters in Europe. Although it is a very specific issue, and many times the approach to major disasters is carried out in a generalist way, the truth is that a burn disaster entails particularities that justify its unique approach. Since year 2000, only eight articles have been published in Europe and there are few publications showing intervention plans already tested and validated on the ground. In Portugal, there were no articles published that approaches this problem, making the rational of this work.

Background: The failure of life-critical systems such as mechanical ventilators in the wake of a pandemic or a disaster may result in death, and therefore, state and federal government agencies must have precautions in place to ensure availability, reliability, and predictability through comprehensive preparedness and response plans.Methods: All 50 state emergency preparedness response plans were extensively examined for the attention given to the critically injured and ill patient population during a pandemic or mass casualty event. Public health authorities of each state were contacted as well.Results: Nine of 51 state plans (17.6 percent) included a plan or committee for mechanical ventilation triage and management in a pandemic influenza event. All 51 state plans relied on the Centers for Disease Control and Prevention Flu Surge 2.0 spreadsheet to provide estimates for their influenza planning. In the absence of more specific guidance, the authors have developed and provided guidelines recommended for ventilator triage and the implementation of the AGILITIES Score in the event of a pandemic, mass casualty event, or other catastrophic disaster.Conclusions: The authors present and describe the AGILITIES Score Ventilator Triage System and provide related guidelines to be adopted uniformly by government agencies and hospitals.This scoring system and the set of guidelines are to be used in disaster settings, such as Hurricane Katrina, and are based on three key factors: relative health, duration of time on mechanical ventilation, and patients’ use of resources during a disaster. For any event requiring large numbers of ventilators for patients, the United States is woefully unprepared. The deficiencies in this aspect of preparedness include (1) lack of accountability for physical ventilators, (2) lack of understanding with which healthcare professionals can safely operate these ventilators, (3) lack of understanding from where additional ventilator resources exist, and (4) a triage strategy to provide ventilator support to those patients with the greatest chances of survival.

Background: The failure of life-critical systems such as mechanical ventilators in the wake of a pandemic or a disaster may result in death, and therefore, state and federal government agencies must have precautions in place to ensure availability, reliability, and predictability through comprehensive preparedness and response plans.Methods: All 50 state emergency preparedness response plans were extensively examined for the attention given to the critically injured and ill patient population during a pandemic or mass casualty event. Public health authorities of each state were contacted as well.Results: Nine of 51 state plans (17.6 percent) included a plan or committee for mechanical ventilation triage and management in a pandemic influenza event. All 51 state plans relied on the Centers for Disease Control and Prevention Flu Surge 2.0 spreadsheet to provide estimates for their influenza planning. In the absence of more specific guidance, the authors have developed and provided guidelines recommended for ventilator triage and the implementation of the AGILITIES Score in the event of a pandemic, mass casualty event, or other catastrophic disaster.Conclusions: The authors present and describe the AGILITIES Score Ventilator Triage System and provide related guidelines to be adopted uniformly by government agencies and hospitals. This scoring system and the set of guidelines are to be used in disaster settings, such as Hurricane Katrina, and are based on three key factors: relative health, duration of time on mechanical ventilation, and patients’ use of resources during a disaster. For any event requiring large numbers of ventilators for patients, the United States is woefully unprepared. The deficiencies in this aspect of preparedness include (1) lack of accountability for physical ventilators, (2) lack of understanding with which healthcare professionals can safely operate these ventilators, (3) lack of understanding from where additional ventilator resources exist, and (4) a triage strategy to provide ventilator support to those patients with the greatest chances of survival.

IntroductionAssociated with hospital evacuation is the need to track multiple patient evacuees from point of origination to final hospital reception. Patient tracking, a component of the hospital emergency operations plan, is vital to patient care; family association, resource management, financial reimbursement, risk management, and repatriation. Tracking strategies and plans can include a variety of vendors, hardware, software, and coordination issues. Hospital evacuee tracking plans and platforms exist at multiple jurisdictional levels but may not be interoperable.MethodsThree patient tracking platforms representing a local, state and federal application were used during a multi-hospital evacuation exercise, initiated in New Orleans, Louisiana, May 2010. Simulated patients were flown and tracked to multiple patient reception centers in the southern United States, including the Federal Coordinating Center in Shreveport, Louisiana, and receiving National Disaster Medical System hospitals. This review summarizes tracking operations, patient data characteristics captured and interoperability at the Shreveport reception location.Results7 New Orleans hospitals entered 51 patients for evacuation into Louisiana's web-based, At-Risk-Registry (ARR) database including 8 patient identifiers each. ARR data was shared with federal and Louisiana Region 7 patient evacuee receivers for flight manifest construction and reception planning. 34 ARR evacuee patients were indicated for the Shreveport, Louisiana, reception site. 34 patients with 6 identifying characteristics were entered from ARR into EMTrack, the local patient tracking system. A C130 arrived with a TRAC2ES manifest of 20 simulated patients with 6 patient data characteristics. The local tracking system was reconfigured for the hardcopy manifest; simulated patients were received at the airport; transported and received at local hospitals.ConclusionsTracking system interoperability may be challenged by tracking technologies, jurisdictional requirements and degree of implementation at the local, state and federal level. Tracking should be standardized based on national recommendations with local systems remaining flexible for just-in-time requirements.

Introduction:In the United States, tornadoes are the third leading cause of fatalities from natural disasters1. To aid prevention and mitigation of tornado-related morbidity and mortality, improvement in standardizing tornado specific threat analysis terminology was assessed. The largest number of tornado-related fatalities has occurred in the state of Texas for over a hundred years. The occurrence of tornadic clusters or “outbreaks” has not been formally standardized. The concept of “tornado outbreaks” is better defined and its role in fatality mitigation is addressed in this Institutional Review Board (IRB) approved study.Aim:To understand the role of “tornado outbreaks” related clusters in Texas in relationship to morbidity and mortality.Methods:This IRB approved (IRB2017- 0507) research study utilized GIS tools and statistical analysis of historical data to examine the relationship between tornado severity (based on the Fujita Scale), the number of tornadoes, and the trends in morbidity and mortality. This study was funded in part from The National Science Foundation grant (NSF Grant #1560106) in support of the CyberHealthGIS Research Experience for Undergraduates (REU).Results:A statistically significant difference was demonstrated between the severity of a tornado and related morbidity and mortality during “tornado outbreaks” in Texas during a defined 30-year period.Discussion:Understanding the role and discerning the impacts of “tornado outbreaks” as related to tornado severity has critical implications to disaster preparedness. Applications of this conclusion may improve shelter planning/preparation, timely warning, and educating the at-risk public. Subsequently, examining the likelihood and improved descriptions of “tornado outbreaks” may aid in reducing the number of tornado-related injuries and fatalities nationally.

AbstractIntroduction:On 18 July 2001, a train hauling hazardous materials, including hydrochloric acid, hydrofluoric acid, and acetic acid, derailed in the city of Baltimore, Maryland, resulting in a fire that burned under a downtown street for five days. Firefighters were stymied in their efforts to extinguish the fire, and the city was subjected to thick smoke for several days.Objectives:To determine whether an urban chemical fire with a hazardous materials spill resulted in a detectable public health impact, and to demo-graphically describe the at-risk population for potential smoke and chemical exposure.Methods:The United States Centers for Disease Control and Prevention (CDC) was consulted about possible side effects from chemical exposure. Total numbers of emergency department (ED) patients and admissions from 15:00 hours (h), 15 July 2001 to 15:00 h, 21 July 2001 were collected from five local hospitals. Patient encounters citing specified chief complaints from 15:00 h, 15 July to 15:00 h, 18 July (pre-accident) were compared with the period from 15:00 h, July 18 to 15:00 h, 21 July (post-accident). Data were analyzed using Fisher's exact test. The United States Census Bureau's Topologically Integrated Geographic Encoding and Referencing (TIGER) digital database of geographic features and ArcView Geographic Information Systems (GIS) were used to create maps of Baltimore and to identify populations at-risk using attribute census data. Results: There were 62,808 people residing in the immediate, affected area. The mean of the values for age was 33.7 ±3.2 years (standard deviation; range = 16 yrs) with 49% (30,927) males and 51% (31,881) females. A total of 2,922 ED patient encounters were screened. Chief complaints included shortness of breath, pre-event = 109 vs. post-event = 148; chest complaints = 90 vs. 113; burns and/or skin irritation = 45 vs. 42; eye irritation 26 vs. 34; throat irritation = 33 vs. 27; and smoke exposure = 0 vs. 15. There was a statistically significant increase (p <0.05) for shortness of breath and smoke exposure-related complaints. No statistically significant increase in numbers of admitted patients with these complaints was found.Conclusions:In the setting of a large-scale urban chemical fire, local EDs can expect a significant increase in the number of patients presenting to EDs with shortness of breath and/or smoke inhalation. Most do not require inpatient hospitalization. Careful assessment of impact on local EDs should be considered in future city-accident planning. Some official warnings were widely misinterpreted or ignored. Public education on potential hazards and disaster preparedness targeted to populations at-risk should receive a high priority. Geographic information systems (GIS) may serve as useful tools for identifying demographics of populations at-risk for disaster planning and responses.

Objective: To assess the level of pandemic preparedness at emergency departments (EDs) around the country and to better understand current barriers to preparedness in the United States represented by health professionals in the American College of Emergency Physician (ACEP) Disaster Medicine Section (DMS).Methods, design, and setting: A cross-sectional survey of ACEP DMS members was performed. A total of 300 members were surveyed both via e-mail and with paper surveys during the 2009 ACEP Scientific Assembly DMS Meeting. An optional comments section was included for section members’ perspectives on barriers to preparedness. A 15-item pandemic preparedness score was calculated for each respondent based on key preparedness indicators as defined by the authors. Results were analyzed with descriptive statistics, ᵪ2 analysis, Cochran-Armitage trend test, and analysis of variance. Free text comments were coded and subjected to frequency-based analysis.Results: A total of 92 DMS members completed the survey with a response rate of 31 percent. Although 85 percent of those surveyed indicated that their hospital had a plan for pandemic influenza response and other infectious disease threats, only 68 percent indicated that their ED had a plan, and 52 percent indicated that their hospital or ED had conducted disaster preparedness drills. Only 57 percent indicated that there was a plan to augment ED staff in the event of a staffing shortage, and 63 percent indicated that there were adequate supplies of personal protective equipment.While 63 percent of respondents indicated that their ED had a plan for distribution of vaccines and antivirals, only 32 percent of EDs had a plan for allocation of ventilators.A total of 42 percent of respondents felt that their ED was prepared in the event of a pandemic influenza or other disease outbreak, and only 35 percent felt that their hospital was prepared. The average pandemic preparedness score among respondents was 8.30 of a total of 15. Larger EDs were more likely to have a higher preparedness score (p = 0.03) and more likely to have a pandemic preparedness plan (p = 0.037). Some major barriers to preparedness cited by section members included lack of local administration support, challenges in funding, need for dedicated disaster preparedness personnel, staffing shortages, and a lack of communication among disaster response agencies, particularly at the federal level.Conclusions: There appear to be significant gaps in pandemic influenza and other infectious disease outbreak planning among the hospitals where ACEP DMS members work.This may reflect a broader underlying inadequacy of preparedness measures.

Objective: To assess the level of pandemic preparedness at emergency departments (EDs) around the country and to better understand current barriers to preparedness in the United States represented by health professionals in the American College of Emergency Physician (ACEP) Disaster Medicine Section (DMS).Methods, design, and setting: A cross-sectional survey of ACEP DMS members was performed. A total of 300 members were surveyed both via e-mail and with paper surveys during the 2009 ACEP Scientific Assembly DMS Meeting. An optional comments section was included for section members’ perspectives on barriers to preparedness. A 15-item pandemic preparedness score was calculated for each respondent based on key preparedness indicators as defined by the authors. Results were analyzed with descriptive statistics, χ2 analysis, Cochran-Armitage trend test, and analysis of variance. Free text comments were coded and subjected to frequency-based analysis.Results: A total of 92 DMS members completed the survey with a response rate of 31 percent. Although 85 percent of those surveyed indicated that their hospital had a plan for pandemic influenza response and other infectious disease threats, only 68 percent indicated that their ED had a plan, and 52 percent indicated that their hospital or ED had conducted disaster preparedness drills. Only 57 percent indicated that there was a plan to augment ED staff in the event of a staffing shortage, and 63 percent indicated that there were adequate supplies of personal protective equipment. While 63 percent of respondents indicated that their ED had a plan for distribution of vaccines and antivirals, only 32 percent of EDs had a plan for allocation of ventilators. A total of 42 percent of respondents felt that their ED was prepared in the event of a pandemic influenza or other disease outbreak, and only 35 percent felt that their hospital was prepared. The average pandemic preparedness score among respondents was 8.30 of a total of 15. Larger EDs were more likely to have a higher preparedness score (p = 0.03) and more likely to have a pandemic preparedness plan (p = 0.037). Some major barriers to preparedness cited by section members included lack of local administration support, challenges in funding, need for dedicated disaster preparedness personnel, staffing shortages, and a lack of communication among disaster response agencies, particularly at the federal level.Conclusions: There appear to be significant gaps in pandemic influenza and other infectious disease outbreak planning among the hospitals where ACEP DMS members work. This may reflect a broader underlying inadequacy of preparedness measures.

When disasters and other broad-scale public health emergencies occur in the United States, they often reveal flaws in the pre-event preparedness of those individuals and agencies charged with responsibility for emergency response and recovery activities. A significant contributor to this problem is the unwillingness of some public health workers to participate in the requisite planning, training, and response activities to ensure quality preparedness.The thesis of this article is that there are numerous, empirically supported models of behavior change that hold potential for motivating role-appropriate behavior in public health professionals. The models that are highlighted here for consideration and prospective adaptation to the public health emergency preparedness system (PHEPS) are the Transtheoretical Model of Intentional Behavior Change (TTM) and Motivational Interviewing (MI). Core concepts in TTM and MI are described, and specific examples are offered to illustrate the relevance of the frameworks for understanding and ameliorating PHEPS-based workforce problems. Finally, the requisite steps are described to ensure the readiness of organizations to support the implementation of the ideas proposed.

Introduction:Homeless individuals may be dependent on social services for nutrition, shelter, and protection. These services are susceptible to disruption in disasters. Individuals are often frequent utilizers of emergency health care services, and an increase in emergency medical services utilization may be predictable. Disaster planners should anticipate and plan for the needs of these special populations.1Methods:A review of disaster planning in US cities with high rates of homelessness was conducted. Utilizing homelessness census data, the five cities with the largest homeless population were chosen for analysis. Publicly available disaster plans specifically targeting at homeless were identified. Planning for nutritional support, shelter, protection, and emergency healthcare utilization was identified.Results:Planning specifically addressing the needs of the homeless was variable. Planning items surrounding nutrition and shelter were identified, but those around protection and use of emergency services were more limited.Discussion:Recent disasters in the United States have demonstrated the increased vulnerability of populations with high utilization of emergency services during a disaster.2 Homelessness is common throughout the United States, and appear to be underrepresented at the city disaster planning level.3 Resources to assist planners are available, but increased adoption is indicated.

Abstract This study examines how tornado risk and societal exposure interact to create tornado disaster potential in the United States. Finescale historical and projected demographic data are used in a set of region-specific Monte Carlo tornado simulations to reveal how societal development has shaped, and will continue to shape, tornado disaster frequency and consequences. Results illustrate that although the U.S. Midwest contains the greatest built-environment exposure and the central plains experience the most significant tornadoes, the midsouth contains the greatest tornado disaster potential. This finding is attributed to the relatively elevated tornado risk and accelerated growth in developed land area that characterizes the midsouth region. Disaster potential is projected to amplify in the United States due to increasing built-environment development and its spatial footprint in at-risk regions. In the four regions examined, both average annual tornado impacts and associated impact variability are projected to be as much as 6 to 36 times greater in 2100 than 1940. Extreme annual tornado impacts for all at-risk regions are also projected to nearly double during the twenty-first century, signifying the potential for greater tornado disaster potential in the future. The key lesson is that it is the juxtaposition of both risk and societal exposure that drive disaster potential. Mitigation efforts should evaluate changes in tornado hazard risk and societal exposure in light of land-use planning, building codes, and warning dissemination strategies in order to reduce the effects of tornadoes and other environmental hazards.

In accordance with the 1973 Emergency Medical Services Systems Act in the United States, one of the 15 functions to be performed by every EMS (Emergency Medical Services) system is disaster planning. The predicate of success in remediating such a macrosystem challenge as regional disaster planning requires the consensus of multidisciplinary health care and public safety human resources prior to the effective cataloging of physical resources. As the emergency physician is the medical leader of EMS system design and implementation, it is important that he explore newly developing disaster planning methodologies to facilitate consensus disaster planning.

After Hurricane Katrina’s devastation of the United States’ Gulf Coast, conversations about flooding became focused on the interconnections between so-called “natural” disasters, poverty, gender and race. Although research has long shown that women, people of color and low-income communities are more vulnerable to natural hazards, the disproportionate effects of Hurricane Katrina and subsequent federal and state disaster response efforts forced the national spotlight on the institutional and systemic nature of racism, classism and sexism. Using Black feminism and radical planning theory, two lenses that provides a comprehensive framework for understanding racism, classism and sexism, this article examines the concept and literature of social vulnerability. I argue while social vulnerability research has made significant contributions to planners’ understandings of disasters and inequity, it fails to center community knowledge, identify intersectional oppressions and name them as such and encourage community activism, all of which are keys to making meaningful change.

AbstractBackgroundThe increase in natural and man-made disasters occurring worldwide places Emergency Medicine (EM) physicians at the forefront of responding to these crises. Despite the growing interest in Disaster Medicine, it is unclear if resident training has been able to include these educational goals.HypothesisThis study surveys EM residencies in the United States to assess the level of education in Disaster Medicine, to identify competencies least and most addressed, and to highlight effective educational models already in place.MethodsThe authors distributed an online survey of multiple-choice and free-response questions to EM residency Program Directors in the United States between February 7 and September 24, 2014. Questions assessed residency background and details on specific Disaster Medicine competencies addressed during training.ResultsOut of 183 programs, 75 (41%) responded to the survey and completed all required questions. Almost all programs reported having some level of Disaster Medicine training in their residency. The most common Disaster Medicine educational competencies taught were patient triage and decontamination. The least commonly taught competencies were volunteer management, working with response teams, and special needs populations. The most commonly identified methods to teach Disaster Medicine were drills and lectures/seminars.ConclusionThere are a variety of educational tools used to teach Disaster Medicine in EM residencies today, with a larger focus on the use of lectures and hospital drills. There is no indication of a uniform educational approach across all residencies. The results of this survey demonstrate an opportunity for the creation of a standardized model for resident education in Disaster Medicine.SarinRR, CattamanchiS, AlqahtaniA, AljohaniM, KeimM, CiottoneGR. Disaster education: a survey study to analyze disaster medicine training in emergency medicine residency programs in the United States. Prehosp Disaster Med. 2017;32(4):368–373.

Water resources planning and management has evolved in the United States through several distinct stages over the past two centuries, transitioning from a concern for inland waterways transportation to single purpose flood control and finally to multiple purpose large reservoirs. Disaster risk reduction (DRR) was always considered to be one of the main goals of these strategies. Reviewing history, this paper describes a US federal system that presents major challenges to coordinating water resources development and DRR, at both the watershed and metropolitan area scales. The paper reviews the performance of existing flood protection systems of three recent disasters. Federal, state and local responses to these major events have been mixed, as regulatory and management agencies with different evaluation frameworks and decision rules attempt to coordinate their respective responses. The cases revealed new vulnerabilities and weaknesses in the US DRR responses and planning, while contrasting the relative successes of long-term, strategic DRR planning and investments in the case of the Mississippi River and Tributaries (MR&T) system. The paper analyzes this history and recent cases primarily from the perspective of the US Army Corps of Engineers.

Introduction: Societal risks from hazards are continually increasing. Each year, disasters cause thousands of deaths and cost billions of dollars. In the first half of 2011, the United States endured countless disasters—winter snowstorms in the Midwest and Northeast; severe tornadic weather in the Mississippi, Alabama, and Missouri; flash flooding in Nashville; flooding along the Mississippi River; an earthquake on the East Coast, wildfires in Texas, and Hurricane Irene. Fundamental disaster planning is regarded as an interdisciplinary approach to develop strategies and instituting policies concerned with phases of emergency management; as such, its needs are predicated on the identification of hazards and assessment of risks.Problem: Even if the probability or intensity of risks to disasters remains fairly constant, population growth, alongside economic and infrastructural development, will unavoidably result in a concomitant increase of places prone to such events. One of the greatest barriers to emergency management efforts is the failure to fully grasp the socially and politically constructed meaning of disasters.Purpose: This article investigates the ways in which language has been used historically in the American lexicon to make sense of disasters in the United States in an effort to improve communal resiliency. Serving as both an idea and experience, the terminology used to convey our/the modern-day concept of disaster is a result of a cultural artifact, ie, a given time and specific place.Methodology: Tools such as Google Ngram Viewer and CASOS AutoMap are used to explore the penetration, duration, and change in disaster terminology among American English literature for more than 200 years, from 1800 to 2008, by quantifying written culture.Findings: The language of disasters is an integral part of disaster response, as talking is the primary way that most people respond to and recover from disasters. The vast majority of people are not affected by any given disaster, and so it is through discussing a disaster that people make sense of it, respond, and react to it, and fit something that is overwhelming and beyond human control into the normal order of life.

In this issue of Journal of Disaster Research, we introduce nine papers on societal responses to recent catastrophic disasters with special focus on long-term recovery processes in Japan and the United States. As disaster impacts increase, we also find that recovery times take longer and the processes for recovery become more complicated. On January 17th of 1995, a magnitude 7.2 earthquake hit the Hanshin and Awaji regions of Japan, resulting in the largest disaster in Japan in 50 years. In this disaster which we call the Kobe earthquake hereafter, over 6,000 people were killed and the damage and losses totaled more than 100 billion US dollars. The long-term recovery from the Kobe earthquake disaster took more than ten years to complete. One of the most important responsibilities of disaster researchers has been to scientifically monitor and record the long-term recovery process following this unprecedented disaster and discern the lessons that can be applied to future disasters. The first seven papers in this issue present some of the key lessons our research team learned from the studying the long-term recovery following the Kobe earthquake disaster. We have two additional papers that deal with two recent disasters in the United States – the terrorist attacks on World Trade Center in New York on September 11 of 2001 and the devastation of New Orleans by the 2005 Hurricane Katrina and subsequent levee failures. These disasters have raised a number of new research questions about long-term recovery that US researchers are studying because of the unprecedented size and nature of these disasters’ impacts. Mr. Mammen’s paper reviews the long-term recovery processes observed at and around the World Trade Center site over the last six years. Ms. Johnson’s paper provides a detailed account of the protracted reconstruction planning efforts in the city of New Orleans to illustrate a set of sufficient and necessary conditions for successful recovery. All nine papers in this issue share a theoretical framework for long-term recovery processes which we developed based first upon the lessons learned from the Kobe earthquake and later expanded through observations made following other recent disasters in the world. The following sections provide a brief description of each paper as an introduction to this special issue. 1. The Need for Multiple Recovery Goals After the 1995 Kobe earthquake, the long-term recovery process began with the formulation of disaster recovery plans by the City of Kobe – the most severely impacted municipality – and an overarching plan by Hyogo Prefecture which coordinated 20 impacted municipalities; this planning effort took six months. Before the Kobe earthquake, as indicated in Mr. Maki’s paper in this issue, Japanese theories about, and approaches to, recovery focused mainly on physical recovery, particularly: the redevelopment plans for destroyed areas; the location and standards for housing and building reconstruction; and, the repair and rehabilitation of utility systems. But the lingering problems of some of the recent catastrophes in Japan and elsewhere indicate that there are multiple dimensions of recovery that must be considered. We propose that two other key dimensions are economic recovery and life recovery. The goal of economic recovery is the revitalization of the local disaster impacted economy, including both major industries and small businesses. The goal of life recovery is the restoration of the livelihoods of disaster victims. The recovery plans formulated following the 1995 Kobe earthquake, including the City of Kobe’s and Hyogo Prefecture’s plans, all stressed these two dimensions in addition to physical recovery. The basic structure of both the City of Kobe’s and Hyogo Prefecture’s recovery plans are summarized in Fig. 1. Each plan has three elements that work simultaneously. The first and most basic element of recovery is the restoration of damaged infrastructure. This helps both physical recovery and economic recovery. Once homes and work places are recovered, Life recovery of the impacted people can be achieved as the final goal of recovery. Figure 2 provides a “recovery report card” of the progress made by 2006 – 11 years into Kobe’s recovery. Infrastructure was restored in two years, which was probably the fastest infrastructure restoration ever, after such a major disaster; it astonished the world. Within five years, more than 140,000 housing units were constructed using a variety of financial means and ownership patterns, and exceeding the number of demolished housing units. Governments at all levels – municipal, prefectural, and national – provided affordable public rental apartments. Private developers, both local and national, also built condominiums and apartments. Disaster victims themselves also invested a lot to reconstruct their homes. Eleven major redevelopment projects were undertaken and all were completed in 10 years. In sum, the physical recovery following the 1995 Kobe earthquake was extensive and has been viewed as a major success. In contrast, economic recovery and life recovery are still underway more than 13 years later. Before the Kobe earthquake, Japan’s policy approaches to recovery assumed that economic recovery and life recovery would be achieved by infusing ample amounts of public funding for physical recovery into the disaster area. Even though the City of Kobe’s and Hyogo Prefecture’s recovery plans set economic recovery and life recovery as key goals, there was not clear policy guidance to accomplish them. Without a clear articulation of the desired end-state, economic recovery programs for both large and small businesses were ill-timed and ill-matched to the needs of these businesses trying to recover amidst a prolonged slump in the overall Japanese economy that began in 1997. “Life recovery” programs implemented as part of Kobe’s recovery were essentially social welfare programs for low-income and/or senior citizens. 2. Requirements for Successful Physical Recovery Why was the physical recovery following the 1995 Kobe earthquake so successful in terms of infrastructure restoration, the replacement of damaged housing units, and completion of urban redevelopment projects? There are at least three key success factors that can be applied to other disaster recovery efforts: 1) citizen participation in recovery planning efforts, 2) strong local leadership, and 3) the establishment of numerical targets for recovery. Citizen participation As pointed out in the three papers on recovery planning processes by Mr. Maki, Mr. Mammen, and Ms. Johnson, citizen participation is one of the indispensable factors for successful recovery plans. Thousands of citizens participated in planning workshops organized by America Speaks as part of both the World Trade Center and City of New Orleans recovery planning efforts. Although no such workshops were held as part of the City of Kobe’s recovery planning process, citizen participation had been part of the City of Kobe’s general plan update that had occurred shortly before the earthquake. The City of Kobe’s recovery plan is, in large part, an adaptation of the 1995-2005 general plan. On January 13 of 1995, the City of Kobe formally approved its new, 1995-2005 general plan which had been developed over the course of three years with full of citizen participation. City officials, responsible for drafting the City of Kobe’s recovery plan, have later admitted that they were able to prepare the city’s recovery plan in six months because they had the preceding three years of planning for the new general plan with citizen participation. Based on this lesson, Odiya City compiled its recovery plan based on the recommendations obtained from a series of five stakeholder workshops after the 2004 Niigata Chuetsu earthquake. <strong>Fig. 1. </strong> Basic structure of recovery plans from the 1995 Kobe earthquake. <strong>Fig. 2. </strong> “Disaster recovery report card” of the progress made by 2006. Strong leadership In the aftermath of the Kobe earthquake, local leadership had a defining role in the recovery process. Kobe’s former Mayor, Mr. Yukitoshi Sasayama, was hired to work in Kobe City government as an urban planner, rebuilding Kobe following World War II. He knew the city intimately. When he saw damage in one area on his way to the City Hall right after the earthquake, he knew what levels of damage to expect in other parts of the city. It was he who called for the two-month moratorium on rebuilding in Kobe city on the day of the earthquake. The moratorium provided time for the city to formulate a vision and policies to guide the various levels of government, private investors, and residents in rebuilding. It was a quite unpopular policy when Mayor Sasayama announced it. Citizens expected the city to be focusing on shelters and mass care, not a ban on reconstruction. Based on his experience in rebuilding Kobe following WWII, he was determined not to allow haphazard reconstruction in the city. It took several years before Kobe citizens appreciated the moratorium. Numerical targets Former Governor Mr. Toshitami Kaihara provided some key numerical targets for recovery which were announced in the prefecture and municipal recovery plans. They were: 1) Hyogo Prefecture would rebuild all the damaged housing units in three years, 2) all the temporary housing would be removed within five years, and 3) physical recovery would be completed in ten years. All of these numerical targets were achieved. Having numerical targets was critical to directing and motivating all the stakeholders including the national government’s investment, and it proved to be the foundation for Japan’s fundamental approach to recovery following the 1995 earthquake. 3. Economic Recovery as the Prime Goal of Disaster Recovery In Japan, it is the responsibility of the national government to supply the financial support to restore damaged infrastructure and public facilities in the impacted area as soon as possible. The long-term recovery following the Kobe earthquake is the first time, in Japan’s modern history, that a major rebuilding effort occurred during a time when there was not also strong national economic growth. In contrast, between 1945 and 1990, Japan enjoyed a high level of national economic growth which helped facilitate the recoveries following WWII and other large fires. In the first year after the Kobe earthquake, Japan’s national government invested more than US$ 80 billion in recovery. These funds went mainly towards the repair and reconstruction of infrastructure and public facilities. Now, looking back, we can also see that these investments also nearly crushed the local economy. Too much money flowed into the local economy over too short a period of time and it also did not have the “trickle-down” effect that might have been intended. To accomplish numerical targets for physical recovery, the national government awarded contracts to large companies from Osaka and Tokyo. But, these large out-of-town contractors also tended to have their own labor and supply chains already intact, and did not use local resources and labor, as might have been expected. Essentially, ten years of housing supply was completed in less than three years, which led to a significant local economic slump. Large amounts of public investment for recovery are not necessarily a panacea for local businesses, and local economic recovery, as shown in the following two examples from the Kobe earthquake. A significant national investment was made to rebuild the Port of Kobe to a higher seismic standard, but both its foreign export and import trade never recovered to pre-disaster levels. While the Kobe Port was out of business, both the Yokohama Port and the Osaka Port increased their business, even though many economists initially predicted that the Kaohsiung Port in Chinese Taipei or the Pusan Port in Korea would capture this business. Business stayed at all of these ports even after the reopening of the Kobe Port. Similarly, the Hanshin Railway was severely damaged and it took half a year to resume its operation, but it never regained its pre-disaster readership. In this case, two other local railway services, the JR and Hankyu lines, maintained their increased readership even after the Hanshin railway resumed operation. As illustrated by these examples, pre-disaster customers who relied on previous economic output could not necessarily afford to wait for local industries to recover and may have had to take their business elsewhere. Our research suggests that the significant recovery investment made by Japan’s national government may have been a disincentive for new economic development in the impacted area. Government may have been the only significant financial risk-taker in the impacted area during the national economic slow-down. But, its focus was on restoring what had been lost rather than promoting new or emerging economic development. Thus, there may have been a missed opportunity to provide incentives or put pressure on major businesses and industries to develop new businesses and attract new customers in return for the public investment. The significant recovery investment by Japan’s national government may have also created an over-reliance of individuals on public spending and government support. As indicated in Ms. Karatani’s paper, individual savings of Kobe’s residents has continued to rise since the earthquake and the number of individuals on social welfare has also decreased below pre-disaster levels. Based on our research on economic recovery from the Kobe earthquake, at least two lessons emerge: 1) Successful economic recovery requires coordination among all three recovery goals – Economic, Physical and Life Recovery, and 2) “Recovery indices” are needed to better chart recovery progress in real-time and help ensure that the recovery investments are being used effectively. Economic recovery as the prime goal of recovery Physical recovery, especially the restoration of infrastructure and public facilities, may be the most direct and socially accepted provision of outside financial assistance into an impacted area. However, lessons learned from the Kobe earthquake suggest that the sheer amount of such assistance may not be effective as it should be. Thus, as shown in Fig. 3, economic recovery should be the top priority goal for recovery among the three goals and serve as a guiding force for physical recovery and life recovery. Physical recovery can be a powerful facilitator of post-disaster economic development by upgrading social infrastructure and public facilities in compliance with economic recovery plans. In this way, it is possible to turn a disaster into an opportunity for future sustainable development. Life recovery may also be achieved with a healthy economic recovery that increases tax revenue in the impacted area. In order to achieve this coordination among all three recovery goals, municipalities in the impacted areas should have access to flexible forms of post-disaster financing. The community development block grant program that has been used after several large disasters in the United States, provide impacted municipalities with a more flexible form of funding and the ability to better determine what to do and when. The participation of key stakeholders is also an indispensable element of success that enables block grant programs to transform local needs into concrete businesses. In sum, an effective economic recovery combines good coordination of national support to restore infrastructure and public facilities and local initiatives that promote community recovery. Developing Recovery Indices Long-term recovery takes time. As Mr. Tatsuki’s paper explains, periodical social survey data indicates that it took ten years before the initial impacts of the Kobe earthquake were no longer affecting the well-being of disaster victims and the recovery was completed. In order to manage this long-term recovery process effectively, it is important to have some indices to visualize the recovery processes. In this issue, three papers by Mr. Takashima, Ms. Karatani, and Mr. Kimura define three different kinds of recovery indices that can be used to continually monitor the progress of the recovery. Mr. Takashima focuses on electric power consumption in the impacted area as an index for impact and recovery. Chronological change in electric power consumption can be obtained from the monthly reports of power company branches. Daily estimates can also be made by tracking changes in city lights using a satellite called DMSP. Changes in city lights can be a very useful recovery measure especially at the early stages since it can be updated daily for anywhere in the world. Ms. Karatani focuses on the chronological patterns of monthly macro-statistics that prefecture and city governments collect as part of their routine monitoring of services and operations. For researchers, it is extremely costly and virtually impossible to launch post-disaster projects that collect recovery data continuously for ten years. It is more practical for researchers to utilize data that is already being collected by local governments or other agencies and use this data to create disaster impact and recovery indices. Ms. Karatani found three basic patterns of disaster impact and recovery in the local government data that she studied: 1) Some activities increased soon after the disaster event and then slumped, such as housing construction; 2) Some activities reduced sharply for a period of time after the disaster and then rebounded to previous levels, such as grocery consumption; and 3) Some activities reduced sharply for a while and never returned to previous levels, such as the Kobe Port and Hanshin Railway. Mr. Kimura focuses on the psychology of disaster victims. He developed a “recovery and reconstruction calendar” that clarifies the process that disaster victims undergo in rebuilding their shattered lives. His work is based on the results of random surveys. Despite differences in disaster size and locality, survey data from the 1995 Kobe earthquake and the 2004 Niigata-ken Chuetsu earthquake indicate that the recovery and reconstruction calendar is highly reliable and stable in clarifying the recovery and reconstruction process. <strong>Fig. 3.</strong> Integrated plan of disaster recovery. 4. Life Recovery as the Ultimate Goal of Disaster Recovery Life recovery starts with the identification of the disaster victims. In Japan, local governments in the impacted area issue a “damage certificate” to disaster victims by household, recording the extent of each victim’s housing damage. After the Kobe earthquake, a total of 500,000 certificates were issued. These certificates, in turn, were used by both public and private organizations to determine victim’s eligibility for individual assistance programs. However, about 30% of those victims who received certificates after the Kobe earthquake were dissatisfied with the results of assessment. This caused long and severe disputes for more than three years. Based on the lessons learned from the Kobe earthquake, Mr. Horie’s paper presents (1) a standardized procedure for building damage assessment and (2) an inspector training system. This system has been adopted as the official building damage assessment system for issuing damage certificates to victims of the 2004 Niigata-ken Chuetsu earthquake, the 2007 Noto-Peninsula earthquake, and the 2007 Niigata-ken Chuetsu Oki earthquake. Personal and family recovery, which we term life recovery, was one of the explicit goals of the recovery plan from the Kobe earthquake, but it was unclear in both recovery theory and practice as to how this would be measured and accomplished. Now, after studying the recovery in Kobe and other regions, Ms. Tamura’s paper proposes that there are seven elements that define the meaning of life recovery for disaster victims. She recently tested this model in a workshop with Kobe disaster victims. The seven elements and victims’ rankings are shown in Fig. 4. Regaining housing and restoring social networks were, by far, the top recovery indicators for victims. Restoration of neighborhood character ranked third. Demographic shifts and redevelopment plans implemented following the Kobe earthquake forced significant neighborhood changes upon many victims. Next in line were: having a sense of being better prepared and reducing their vulnerability to future disasters; regaining their physical and mental health; and restoration of their income, job, and the economy. The provision of government assistance also provided victims with a sense of life recovery. Mr. Tatsuki’s paper summarizes the results of four random-sample surveys of residents within the most severely impacted areas of Hyogo Prefecture. These surveys were conducted biannually since 1999,. Based on the results of survey data from 1999, 2001, 2003, and 2005, it is our conclusion that life recovery took ten years for victims in the area impacted significantly by the Kobe earthquake. Fig. 5 shows that by comparing the two structural equation models of disaster recovery (from 2003 and 2005), damage caused by the Kobe earthquake was no longer a determinant of life recovery in the 2005 model. It was still one of the major determinants in the 2003 model as it was in 1999 and 2001. This is the first time in the history of disaster research that the entire recovery process has been scientifically described. It can be utilized as a resource and provide benchmarks for monitoring the recovery from future disasters. <strong>Fig. 4.</strong> Ethnographical meaning of “life recovery” obtained from the 5th year review of the Kobe earthquake by the City of Kobe. <strong>Fig. 5.</strong> Life recovery models of 2003 and 2005. 6. The Need for an Integrated Recovery Plan The recovery lessons from Kobe and other regions suggest that we need more integrated recovery plans that use physical recovery as a tool for economic recovery, which in turn helps disaster victims. Furthermore, we believe that economic recovery should be the top priority for recovery, and physical recovery should be regarded as a tool for stimulating economic recovery and upgrading social infrastructure (as shown in Fig. 6). With this approach, disaster recovery can help build the foundation for a long-lasting and sustainable community. Figure 6 proposes a more detailed model for a more holistic recovery process. The ultimate goal of any recovery process should be achieving life recovery for all disaster victims. We believe that to get there, both direct and indirect approaches must be taken. Direct approaches include: the provision of funds and goods for victims, for physical and mental health care, and for housing reconstruction. Indirect approaches for life recovery are those which facilitate economic recovery, which also has both direct and indirect approaches. Direct approaches to economic recovery include: subsidies, loans, and tax exemptions. Indirect approaches to economic recovery include, most significantly, the direct projects to restore infrastructure and public buildings. More subtle approaches include: setting new regulations or deregulations, providing technical support, and creating new businesses. A holistic recovery process needs to strategically combine all of these approaches, and there must be collaborative implementation by all the key stakeholders, including local governments, non-profit and non-governmental organizations (NPOs and NGOs), community-based organizations (CBOs), and the private sector. Therefore, community and stakeholder participation in the planning process is essential to achieve buy-in for the vision and desired outcomes of the recovery plan. Securing the required financial resources is also critical to successful implementation. In thinking of stakeholders, it is important to differentiate between supporting entities and operating agencies. Supporting entities are those organizations that supply the necessary funding for recovery. Both Japan’s national government and the federal government in the U.S. are the prime supporting entities in the recovery from the 1995 Kobe earthquake and the 2001 World Trade Center recovery. In Taiwan, the Buddhist organization and the national government of Taiwan were major supporting entities in the recovery from the 1999 Chi-Chi earthquake. Operating agencies are those organizations that implement various recovery measures. In Japan, local governments in the impacted area are operating agencies, while the national government is a supporting entity. In the United States, community development block grants provide an opportunity for many operating agencies to implement various recovery measures. As Mr. Mammen’ paper describes, many NPOs, NGOs, and/or CBOs in addition to local governments have had major roles in implementing various kinds programs funded by block grants as part of the World Trade Center recovery. No one, single organization can provide effective help for all kinds of disaster victims individually or collectively. The needs of disaster victims may be conflicting with each other because of their diversity. Their divergent needs can be successfully met by the diversity of operating agencies that have responsibility for implementing recovery measures. In a similar context, block grants made to individual households, such as microfinance, has been a vital recovery mechanism for victims in Thailand who suffered from the 2004 Sumatra earthquake and tsunami disaster. Both disaster victims and government officers at all levels strongly supported the microfinance so that disaster victims themselves would become operating agencies for recovery. Empowering individuals in sustainable life recovery is indeed the ultimate goal of recovery. <strong>Fig. 6.</strong> A holistic recovery policy model.

In September 2007, the United States Department of Homeland Security (DHS) published the National Preparedness Guidelines which advocate a capabilitiesbased planning (CBP) approach to preparedness for state, local, and tribal governments. This article provides an overview of capabilities-based planning and a more specific focus on the aims, objectives, and components of the DHS CBP model. The article also summarizes what scholars have previously suggested are fundamental elements for successful emergency and disaster planning focusing specifically on Quarantelli’s 10 research-based principles. The article evaluates the effectiveness of the DHS CBP model in helping local governments incorporate these fundamental elements into their planning efforts and concludes with an overall assessment of the DHS CBP model as a framework for local planning success.

Objective: To describe, innovate, recommend, and foster the implementation of point-of-care (POC) testing in disaster caches to enhance crisis standards of care and to improve triage, diagnosis, monitoring, treatment, and management of victims and volunteers in complex emergencies and disasters.Design and settings: The authors compared POC testing in United States disaster caches to commercially available POC testing to enhance the caches and to reflect current state-of-the-art diagnostic capabilities. The authors also provided recommendations based on literature review and knowledge from newly developed POC technologies from the UC Davis Pointof-Care Technologies Center.Results: Presently, US POC testing caches comprise chemistry/electrolytes, pregnancy, hemoglobin, cardiac biomarkers, hematology, fecal occult blood, drugs of abuse, liver function, blood gases, and limited infectious diseases. Deficiencies with existing POC tests for cardiac biomarkers, hematology, and infectious diseases should be eliminated. POC resources can be customized for pandemics, complex emergencies, or disasters based on geographic location and potential infectious diseases. Additionally, a new thermally stabilized container can help alleviate environmental stresses that reduce test quality.Conclusions: Innovations in POC technologies can improve response preparedness with enhanced diagnostic capabilities. Several innovations, such as the i-STAT® Wireless, OraQuick ADVANCE® HIV-1/2, VereTrop™ Lab-on-a-Chip, and new compact hematology analyzers will improve test clusters that facilitate evidence-based decision making and crisis standards of care during US national disaster responses. Additionally, strategic resources and operator training should be globally harmonized to improve the efficiency of international responses.