Despite the critical importance of emergency exercises for emergency preparedness, there are major deficiencies in some organizations in managing their exercises. Lack of a comprehensive and systematic approach to emergency exercises can waste organizational resources and diminish the response confidence. The present study was conducted to identify and prioritize influencing success factors for planning, implementing, and improving the exercise process. In this study, a pattern for exercise management process was established based on relevant standards and guidelines. Then, the success and failure factors for each step of a typical exercise were identified based on previous studies. Finally, Fuzzy analytic hierarchy process was used to prioritize the identified influencing factors. Based on literature review and experts' opinions, 28 factors influence the success of emergency exercises. Although relative importance of all factors was close to each other, findings showed that "establishing the base of support for an exercise program," "designing the scenario," "presentations/briefings," "using expert evaluators," and "defining appropriate corrective actions plan" had the greatest impacts on the success of an emergency exercise.

Active shooter planning for special education classrooms requires considerations commensurate to the needs of students with mobility, cognitive, auditory, visual, and communicative limitations. The federally established Run, Hide, Fight response methodology has no modified alternative for students who are not able to meet the criteria to run, hide, or fight. School districts that implement Run, Hide, Fight plans without any modified alternatives for special education students expose a compliance lapse of the American Disabilities Act, the Department of Education's Individuals with Disabilities Education Act, and the National Preparedness Goal. To address this gap in planning, a qualitative analysis of primary source documents determined that there is insufficient active shooter planning guidance requisite to students with Access and Functional Need limitations.

On October 1, 2017 in Las Vegas, Nevada, the largest mass shooting in US history was committed by a shooter high above the Route 91 Harvest Festival. In light of this tragedy and the increasing incidence and prevalence of mass shootings in America, it is important to examine how exposure to traumatic events (specifically mass shootings) affects the mental health of hospital physicians through the treatment of victims. This study sought to examine how witnessing mass shootings through the treatment of shooting victims psychologically affects physicians. Nine physicians who had direct contact with the victims were interviewed, and the data were analyzed for common themes using phenomenology. From the interviews, five central themes emerged: normalization of the event, denial, feelings of guilt, the positive outcomes associated with the event, and the magnitude of the patient volume. These themes show specifically how physicians are impacted by traumatic events and can be used to implement strategies to promote physician mental health.

This study aims to examine the ambiguity and uncertainty surrounding crisis management and the implementation of national recommendations in two public-sector organizations during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic. This study is based on two case studies: a municipality and a county administrative board in Sweden. Data were collected through interviews, surveys, and participation in meetings, and they were analyzed using a practice theory lens. The results demonstrate a lack of knowledge and uncertainty regarding the crisis management structure, leading to conflicting interpretations of rules, recommendations, and decision-making procedures. The somewhat uncoordinated response from central authorities had a significant impact on local handling of the crisis, requiring higher management to spend considerable time interpreting the regulations and adjusting them to the local situation. The lack of clear decision procedures and support from higher management creates frustration and anxiety among operational managers. Organizations struggle to keep up with fast-changing guidelines and implement them effectively, resulting in an increased workload and challenges in prioritizing resources. The study also reveals concerns about the long-term consequences and ability to maintain quality in core activities during a wide-ranging crisis as the COVID-19 pandemic.

In the wake of Hurricane Helene, North Carolina has seen its people come together in extraordinary ways, embodying the spirit of the "whole community" approach. This approach emphasizes the collaboration of various stakeholders, including local residents, businesses, government agencies, and nonprofits, to enhance disaster response and recovery efforts. By involving everyone, it ensures that the diverse needs of the community are met efficiently. This collective effort fosters resilience and strengthens the community's ability to bounce back from adversity. This disaster, of biblical proportions, has tested the state's resilience, but the response has been nothing short of inspiring. This approach not only expedites immediate recovery but also builds long-term resilience by fostering stronger relationships and trust among community members. By continuously involving all stakeholders, it ensures better preparedness for future disasters. Additionally, it promotes sustainable development practices that can mitigate the impact of future emergencies. Faith-based organizations, nongovernmental organizations, and everyday citizens have all united, pulling together to support their fellow neighbors and meet immediate needs long before federal aid could arrive.

There appears to be some confusion, misunderstanding, and unfounded concern about state governments being asked to adopt the recent initiative from the United States (US) Department of Defense regarding a dental health provider's compact for US states and territories. Yet, there needs to be a realization of the significance and priority for joining the Dentist and Dental Hygienist Compact, since it directly incorporates into health care security as a strategy component. While there is a gross lack of research and information shared in this area, this editorial serves to offer such research, information, insight, and clarification to emergency management professionals on the value and necessity to openly support dental compact agreements for all US states and territories.

Emergency evacuation from hospitals is a complicated process. This is on account of multiple categories of occupants of hospitals at any given time. This study was conducted using simulation, which simulated emergency evacuation in a teaching hospital. The aim was to identify defects in stairways and exit doors to propose design modifications to facilitate emergency evacuation. This cross-sectional study was conducted using Pathfinder software. The stages of the study included (1) map and model preparation, (2) field study, (3) simulation of evacuation, and (4) making feasible changes in the dimension of the hospital stairways and exit doors and examining its impact on the efficiency of evacuation processes. In the case where all people can move on their own, the evacuation time was 129.7 seconds. If the occupants of the beds and wheelchairs needed assisted evacuation, the evacuation time was 733.3 seconds, which increased by more than five times. If there were impediments in the building corridors, the evacuation was not complete, and 36 percent of the people could not be evacuated. By considering modification of around 58.6 percent in width and/or area of exit dimensions based on the field visit and its feasibility without making major structural changes, there was a reduction in the evacuation time by 46 percent. The results showed that the modifications of passages could make significant improvements in the evacuation process. This would also lead to the reduction of evacuation time in emergencies.

The recovery phase of the emergency management cycle is understudied. This research aimed to understand the communication preferences of rural residents with low literacy during the recovery phase of a hurricane and flooding disaster. During October and November 2019, three focus groups (n = 32) were conducted with members of church congregations in three small townships in eastern North Carolina. Audio recordings were transcribed and coded for communication preferences and themes. Participants were primarily non-White (62 percent), over age 55 (78 percent), and a majority (70 percent) had completed high school or less education. The primary communication preference for the recovery phase was face-to-face. Television (TV) was seen as an approach to disseminate dates and times for local in-person meetings and provide phone numbers to speak with a "live" person. Social media was not a dominant communication preference. Themes that emerged included the following: (1) governmental response related to repairs and buyout following past hurricanes has been too slow; (2) the elderly and those with low literacy seek in-person attention in their towns; (3) residents feel "forgotten" because resources are concentrated in the county seat. Rural residents prefer face-to-face communication in the recovery phase. Multiple approaches to communication may be most effective to distribute recovery phase opportunities.

The coronavirus disease 2019 (COVID-19) pandemic had dramatic impacts throughout the United States (US). In Cameron County, Texas, along the Texas-Mexico border, the impacts of the virus were felt more severely than in most places in the US. Residents of the county, which has high rates of poverty, many multigenerational households, high levels of underlying conditions, and an uninsured population of almost 30 percent, were not only poised to be affected by the virus but also by the response policies put in place to contain it. This study seeks to add to the literature by examining the lived experiences of low-income individuals in Cameron County, Texas, as it relates to the COVID-19 response and their experiences with the response. To do this, we asked: How did the COVID-19 response affect low-income residents in Cameron County, Texas?

The blast on August 4, 2020, which destroyed main parts of the Port of Beirut, was one of the largest chemical explosions in history. This incident is considered one of the events of the Natural Hazards Triggering Technological Accidents (Natech) group, which is accompanied by explosion, fire, and leakage of gaseous toxic materials.