Community Disaster Planning Research Articles

Engaging Young People in Community-based Flood Risk Management in Pekalongan, Indonesia

This technical report describes a capacity development project for flood risk management in Indonesia. The project aimed to equip tertiary students, referred to as 'learners,' with the basic knowledge and skills for flood risk management. We adopted a holistic approach that integrated online lectures, remote coaching and locally-based activities. We implemented a wide range of field activities to foster collaborative experiential learning. Our project took place in Pekalongan, a coastal city in Central Java Province. The significance of our efforts was underscored by the formal endorsement and support provided by the City Government of Pekalongan, which actively engaged 18 government officials in our programme. The capacity development project was structured into two parts. The first part encompassed six online lectures, delving into various aspects of flood risk management. In the second part, 18 enthusiastic Indonesian students took part in our field activities, which included water quality testing, flood exposure assessment, community vulnerability evaluation and community disaster planning. The majority of participants conveyed that the project either met or surpassed their expectations, significantly altering their understanding of climate change and climate vulnerability in Indonesia, while also redefining their roles in local climate change adaptation efforts.

Nursing Home Administrators' Experiences of Work Stress and Intention to Quit during the COVID-19 Pandemic.

The COVID-19 pandemic negatively impacted nursing home administrators (NHAs). This study explores licensed and employed NHA's perceptions about what work stress events would drive their turnover intentions (TI) in year three of the pandemic. As part of a larger survey-based research project collecting numerical and textual data, this study conducted content analysis with qualitative data. Narrative data from 3,859 discrete responses of 1,139 NHAs, from 50 states and Washington D.C, on two open-ended electronic survey questions asking about their work stress and TI were collected February - March 2022. Categories and subcategories were counted and discussed in context as themes. We identified 4 main narrative categories with subcategories about NHA's stress about the regulatory system (e.g., excessive, conflicting, changing regulations), staffing (e.g., insufficient, agency staff), organizational pressures (e.g., work overload), and macro system stressors (e.g. media representation of nursing homes). Three main TI categories with subcategories were identified: the LTC setting and system (e.g., regulatory demands, staffing, facility surveys); personal factors (e.g. stress, career opportunities), and others (e.g., "I would never quit," or "I already decided to quit"). Whole community disaster planning, person-centered surveyor training, improved regulatory guidance, simplified reporting, adequate guidance assistance, and adequate staff could mitigate NHA stress and TI during crises. Administrator resilience should be recognized. Solutions for supporting NHAs can include long-term care industry participation in public health disaster preparedness coalitions, consistent regulatory guidelines with established communication channels, and ongoing crisis leadership training for administrators.

Traditional Indigenous Ecological Knowledge to Enhance Community-Based Disaster Resilience: Taiwan Mountain Area

The Sendai and Hyogo Frameworks emphasize integrating modern science with Indigenous knowledge, a bottom-up community-based disaster management approach. However, a top-down disaster management mechanism and a lack of awareness about Indigenous knowledge are part of the current reality in Taiwan. This study chose the great Cinsbu, an Atayal community in Taiwan, as a case study area, using interviews to explore traditional ecological knowledge in Indigenous people’s daily lives. The study also applies a bottom-up, community-based approach through workshops. This study’s goals are to apply Indigenous knowledge to improve community disaster planning and to work with communities to assist them in utilizing their (Indigenous) knowledge and resources. As a key to achieving disaster resilience, the study highlights three approaches based on traditional ecological knowledge: the natural environment, agriculture production, and social capital. The natural environment approach integrates modern science and traditional ecological knowledge through community risk mapping. The agriculture production approach conserves seeds and stores food using traditional methods, such as pickling and storing in traditional barns. The social capital approach establishes a disaster management organization based on social networking. Finally, the community develops hazard preparedness and disaster response measures based on traditional ecological knowledge. These measures can be integrated with existing disaster management to form a specific mechanism for Indigenous communities.

Evaluating California nursing homes' emergency preparedness for wildfire exposure.

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

We're ready! Effectiveness of community disaster preparedness workshops across different community groups in Alberta, Canada

Despite the increase in disasters in Canada, communities are not well prepared. We're Ready! is a community disaster preparedness workshop that was developed and piloted in 2016 and 2019 in Alberta, Canada with three types of communities: geographical, ethnic, workplace. We're Ready! was designed to address the lack of emergency preparation and response at the household and community-level, especially in ethnic, geographical, and workplace communities. The workshop integrates hands-on learning, disaster simulation, and community-engaged approaches with the aim of strengthening social connections and designing customized community disaster plans. Assessments of the three We're Ready! workshops were conducted using pre- and post-workshop surveys. The findings suggest that combining interactive presentations paired with hands-on learning was effective. The workshops increased social capital; however, the differences in the community groups and the development of spin-off projects from the ethnic community suggests that community disaster planning is more effective when community connections and social relationships are previously developed. We found that when combining social capital with educational training, communities were more likely to feel that the workshop was highly effective and were more motivated to continue building momentum for emergency preparedness in their households and communities. An implication of the success of the We're Ready! workshops is that communities (social and geographical), with a limited budget but with motivated members, can adapt the We're Ready! activities to further disaster preparedness and build stronger social connections, thereby enhance their community's disaster resilience.

Utilization of Mobile Integrated Health Providers During a Flood Disaster in South Carolina (USA).

As 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.

Low Compliance of Urgent Care Centers in the United States With Recommendations for Office-Based Disaster Preparedness

The aim of the study was to determine the compliance of urgent care centers in the United States with published recommendations for office-based disaster preparedness. An electronic questionnaire was distributed to urgent care center administrators as identified by the American Academy of Urgent Care Medicine directory. One hundred twenty-two questionnaires of the 872 distributed were available for analysis (14% usable response rate). Twenty-seven percent of centers have an established disaster plan for events that involve their establishment and surrounding community; 49% practice the plan at least once a year, 19% less frequent than once a year, and 32% never practice. Forty-seven percent of centers are familiar with designated emergency shelters and community evacuation plans. Seventeen percent of centers function as part of a surveillance system to provide early detection of any biologic/chemical/nuclear agents. Twenty-two percent of centers take part in local community and hospital disaster planning, exercises, and drills through emergency medical services and public health systems. Five percent of centers aid schools, child care centers, camps, and other child congregate facilities in disaster planning. Twenty-eight percent of centers have an assembled emergency/disaster kit, containing such items as water, first aid supplies, radios, flashlights, batteries, heavy-duty gloves, food, and sanitation supplies. Areas for improvement in urgent care center disaster preparedness were identified, such as developing an office disaster plan that is practiced at least yearly, becoming familiar with designated emergency shelters and community evacuation plans, providing surveillance to detect potential acts of terrorism, assisting community organizations (hospitals, schools, child care centers, etc) in disaster planning, and assembling office emergency/disaster kits.

The use of participatory modeling to promote social learning and facilitate community disaster planning

Abstract Coastal island communities face significant risks associated with increased natural hazards and other impacts associated with climate change. Further, deeply rooted social issues, lack of awareness or information, and inadequate infrastructure and planning may exacerbate risks to island socio-ecological systems. Understanding these relationships is often difficult, given the lack of methods available for communities to explicitly explore anticipated risks and potential adaptation strategies, in relation to the characteristics of their community socio-ecological system. Social learning has also been shown to foster adaptation to environmental changes, build social trust and empower diverse stakeholders, by offering opportunities for groups of individuals to challenge, negotiate and propose new norms, policies or programs. We present a three-phase social learning framework to facilitate stakeholder-driven scenario-based modeling, in order to inform community disaster planning in relation to the potential impacts of a tsunami. The participatory research was conducted in conjunction with a community disaster committee, representing the communities of the North Shore of O‘ahu, Hawai‘i. Through a series of iterative participatory modeling workshops using fuzzy-logic cognitive mapping, the community committee represented, explored and actively questioned their beliefs about the natural hazards that their community faces. Further, the modeling process allowed the committee to represent the communities’ dynamic nature, run tsunami hazard scenarios to quantify potential direct and indirect effects, and explicitly compare trade-offs of competing adaptation strategies. Changes in the committee's model representations that took place over time demonstrate a progression through single-, double- and triple-loop learning, indicating that social learning occurred across individual to institutional levels, and over short- to long-term time scales.

Public Perceptions of Hospital Responsibilities to Those Presenting Without Medical Injury or Illness During a Disaster

BackgroundDuring natural and manmade disasters, the hospital is perceived as a central rallying and care site for the public, for both those with and without emergency medical needs. The expectations of the public may outstrip hospital plans and abilities to provide nonmedical assistance. ObjectiveOur objective was to determine the public expectations of the hospital during disasters regarding resource provision. MethodsA survey was distributed to adult patients or family members at three emergency departments (EDs). Respondents were asked to evaluate hospital responsibility to provide nine resources to those without emergency medical needs, including vaccination, medication refill or replacement, food and water, grief/stress counseling, Federal Emergency Management Agency (FEMA) access assistance, short/long-term shelter, family reunification, and hospital. Additionally, respondents answered questions regarding prior disaster experience and demographics. ResultsThere were 961 respondents (66.9% were female, 47.5% were white, and 44.6% were black). Respondents agreed or strongly agreed that the hospital should provide the following services: event-specific vaccination (84%), medication refill/replacement (76.5%), food and water (61%), grief or stress counseling (53%), FEMA access assistance (52%), short-term shelter (51%), family reunification (50%), long-term shelter (38%), and hospital transportation (29%). Those 36–45 years of age were less likely to expect services (p < 0.05) and non-whites and those with a family member with a medical condition requiring electricity were more likely to expect services (p < 0.001 and p < 0.05, respectively). There were no differences based on frequency of ED use, sex, income, or prior disaster experience. ConclusionThere is a high public expectation that hospitals will provide significant nonmedical disaster relief. Understanding these expectations is essential to appropriate community disaster planning.

Public Expectations for Nonemergency Hospital Resources and Services During Disasters

The public's expectations of hospital services during disasters may not reflect current hospital disaster plans. The objective of this study was to determine the public's expected hospital service utilization during a pandemic, earthquake, and terrorist bombing. A survey was distributed to adult patients or family members at 3 emergency departments (EDs). Participants identified resources and services they expect to need during 3 disaster scenarios. Linear regression was used to describe factors associated with higher expected utilization scores for each scenario. Of the 961 people who participated in the study, 66.9% were women, 47.5% were white, and 44.6% were black. Determinants of higher pandemic resource utilization included persons who were younger (P < .01); non-white (P < .001); had higher ED visits (P < .01), hospitalization (P = .001), or fewer primary care provider visits (P = .001) in the past year; and did not have a reunification plan (P < .001). Determinants of higher earthquake resource utilization included persons who were non-white (P < .001); who were a patient or spouse (vs parent) participating in the study (P < .05 and P = .001); and had higher ED visits in the past year (P = .001). Determinants of higher bombing resource utilization included persons who were female (P = .001); non-white (P < .001); had higher ED (P = .001) or primary care provider (P < .01) visits in past year; and experienced the loss of home or property during a past disaster (P < .05). Public expectations of hospitals during disasters are high, and some expectations are inappropriate. Better community disaster planning and public risk communication are needed.

Children and disasters: A framework for mental health assessment

Background: Providers serving children’s mental health needs face the complexities of tailoring assessments based on developmental stages, family characteristics, school involvement, and cultural and economic factors.This task is even more challenging in the face of a disaster, terrorist incident, or other mass trauma event. Traditional mental health knowledge and skills may not be sufficient to meet children’s needs in these chaotic situations. Unfortunately, disaster planning and response often overlook or only briefly address the unique mental health needs of children. While there is general agreement that children have specific vulnerabilities, few comprehensive plans exist for identifying and addressing children’s mental health needs predisaster and postdisaster.Objectives/methods: Based on a review of the literature, the objectives of this article are to provide an overview of the central tenets of assessment with children throughout the course of a disaster and to propose a framework for disaster mental health assessment that can be used by a variety of providers in community disaster planning and response.Results: Disaster-related assessments are described including surveillance, psychological triage, needs assessment, screening, clinical evaluation, and program evaluation. This article also identifies easily accessible resources for responders and providers who desire to become more familiar with child disaster mental health assessment concepts.Conclusions: The framework described here provides an overview for understanding how assessment can be conducted to identify child and family needs and to inform the delivery of services following a disaster.

Prairie North: A joint civilian/military mass casualty exercise highlights the role of the National Guard in community disaster response

In a joint military/civilian exercise conducted in June 2010, military National Guard medical and decontamination response efforts proved to be paramount in supporting hospital resources to sustain an adequate response during a simulated terrorist event. Traditionally, hospitals include local responders in their disaster preparedness but overlook other available state and federal resources such as the National Guard. Lessons learned from the exercise included the value of regular joint disaster planning and training between the military and civilian medical sectors. Additionally, military communication and medical equipment compatibility with the civilian infrastructure was identified as one of the top areas for the improvement of this joint exercise. Involving the National Guard in community disaster planning provides a valuable medical support asset that can be critical in responding to multiple casualty events. National Guard response is inherently faster than its federal counterpart. Based on the findings from our joint exercise, states are encouraged to incorporate their corresponding National Guard in civilian critical medical infrastructure disaster preparedness activities, as the National Guard can be an integral part of the disaster response efforts in real multiple casualty events.

The Use of U.S. Academic Institutions in Community Medical Disaster Recovery

AbstractObjective: To explore the role of public schools, and other academic institutions, in community medical disaster preparedness and recovery. Methods: A literature search on the subject of public schools utility in community medical disaster preparedness and recovery was performed. Relevant publications were selected, reviewed, and categorized for the strength of evidence. Spatial distribution of schools, and academic facilities, within rural and urban communities using Geographic Information System (GIS) analysis was conducted. GIS of the Northern Virginia (NOVA) region, adjacent to the nation's capital, was used to identify the spatial distribution and relationship of schools, and other academic and healthcare facilities, within rural and urban communities and the walking accessibility distance within a residential area. A group of subject‐matter experts was convened to identify lessons learned and solicit opinions on the use of schools for medical disaster preparedness. All information was integrated in the final assessment of the role of public schools and academic institutions in medical disaster preparedness and recovery. Results: Literature on the use of schools and academic institutions for medical disaster preparedness and recovery is sparse. Meta‐analysis or randomized controlled trials (RCTs) were not found. Most of the relevant information was located in state or federal government websites. Fair evidence supports that: (1) Schools were used, either as healthcare or as shelter facilities, by federal agencies and privately funded humanitarian relief organizations such as the American Red Cross (ARC). Many U.S. states have executed agreements with ARC for such purposes. (2) Schools, on their own, usually lack resources, facilities, and liability coverage to serve as physical and logistic assets for community medical disaster recovery beyond their traditional role of protecting students and staff. (3) University campuses possess educational and infrastructure resources capable of supporting community medical needs following disasters. Some universities have already established emergency preparedness departments, and are recipients of federal and state grants to develop medical disaster educational programs. With modest investments, such programs can be adapted by local schools for additional community outreach activities. (4) GIS analysis can help identify unique physical attributes of schools of interest to medical disaster planning and recovery programs. In the NOVA region, schools have different spatial relationships to the communities and other resources of potential benefit for medical disaster recovery. In the rural areas, schools are not always located within walking distance from residential areas. (5) Community emergency preparedness networks are not fully integrated and may not benefit diverse demographic groups. Discussion: Backed by adequate resources and planning, schools can be used in a dual Function—to care for students and the community. Policy Implications and Conclusions: Schools and other academic institutions should be integrated into community disaster planning and recovery. Best practices from local health departments and privately funded relief organizations, engaging schools, should be incorporated into a nationwide disaster planning framework. NOVA's experience suggests that local health departments can integrate schools into community disaster preparedness and recovery. Adequately funded schools can help with community educational networks for disaster preparedness. Further research into the interdependencies between local health departments and schools and best practices targeting community disaster networking should be undertaken. Limitation: This is a preliminary review intended to identify lessons learned and research gaps in the use of schools for medical disaster preparedness and response. Using the NOVA region, part of the nation's capital region, as a study model may not be applied to other U.S. geographic regions due to the uniqueness of the Washington Metropolitan area. However, the NOVA region may be a good representation of a suburban area. This review is focused on public schools and to some degree state universities. Private schools and/or universities were not included due to the difficulty of acquiring information from parochial organizations and could have introduced additional bias.

A Review of Hurricane Disaster Planning for the Elderly

AbstractFrail elderly people are particularly vulnerable during hurricanes. Of the 1,330 people known to have perished along the Gulf Coast as a result of Hurricane Katrina, 71% of those in Louisiana were older than 60 years, 47% were older than 75 years, and at least 68 died in nursing homes. Unfortunately, community disaster planning frequently fails to allow for the needs of the frail elderly before, during, and after hurricanes. This paper discusses the particular vulnerabilities of the frail elderly, especially those with chronic diseases, those in residential care facilities, and those who are dialysis‐dependent. The importance of the Incident Management System (IMS) is discussed, and those who care for the frail elderly in long‐term care facilities must understand and use IMS in dealing with hurricane‐related disasters. Recommendations are made that will improve hurricane disaster planning for the frail elderly. From a policy viewpoint, it is critical that the elderly, especially those with chronic diseases, be included in disaster planning at the federal, state, and local levels to ensure that a repeat of the Hurricane Katrina debacle does not occur.

Providing Shelter to Nursing Home Evacuees in Disasters: Lessons From Hurricane Katrina

We examined nursing home preparedness needs by studying the experiences of nursing homes that sheltered evacuees from Hurricane Katrina. Five weeks after Hurricane Katrina, and again 15 weeks later, we conducted interviews with administrators of 14 nursing homes that sheltered 458 evacuees in 4 states. Nine weeks after Katrina, we conducted site visits to 4 nursing homes and interviewed 4 administrators and 38 staff members. We used grounded theory analysis to identify major themes and thematic analysis to organize content. Although most sheltering facilities were well prepared for emergency triage and treatment, we identified some major preparedness shortcomings. Nursing homes were not included in community planning or recognized as community health care resources. Supplies and medications were inadequate, and there was insufficient communication and information about evacuees provided by evacuating nursing homes to sheltering nursing homes. Residents and staff had notable mental health-related needs after 5 months, and maintaining adequate staffing was a challenge. Nursing homes should develop and practice procedures to shelter and provide long-term access to mental health services following a disaster. Nursing homes should be integrated into community disaster planning and be classified in an emergency priority category similar to hospitals.

Medical outreach following a remote disaster: Lessons learned from Hurricane Katrina

In the aftermath of Hurricane Katrina, many individuals were evacuated to the Atlanta area (1,306 medical evacuees, over 100,000 self-evacuees), placing considerable strain on an already overburdened healthcare system. With the aim of improving future disaster responsiveness, we designed this in-depth case study to identify systemic vulnerabilities and gaps in community responsiveness to an influx of evacuees from a remote disaster. Qualitative methods were used to interview key informants both individually and in focus groups. Coding and content analysis of transcribed interview data were used to identify shared observations and common themes. Twenty-three individuals in leadership roles at the Woodruff Health Sciences Center of Emory University or the Grady Health System completed individual interviews; an additional 24 healthcare providers participated in focus groups. A strategy-based data-coding scheme for interview data was used to identify key foci, including services that met needs of evacuees, unmet needs, service provision that was successful/unsuccessful, underlying reasons for success or failure, and future needs for disaster planning and responsiveness. Analysis of interview data revealed important accomplishments and deficits in the medical community's response in specific domains of community disaster planning and evaluation. For each key component of community disaster planning and evaluation, there are considerations at the institutional, regional, state, and federal levels. In the current study, these considerations were identified as instrumental in effectively meeting the healthcare needs of the evacuated population.

Community emergency response teams and community disaster planning

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The Psycho-Social Needs of Health Professionals Providing On-Scene Disaster Care

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.

A Study on Community Disaster and Community Medical Service Planning

A Study on Community Disaster and Community Medical Service Planning

Initial findings from a study of socio-behavioral preparations and planning for acute chemical hazard disasters

This paper generally describes research just initiated on the socio-behavioral aspects of disasters resulting from chemical agents, and reports preliminary findings from the first phase of study. These initial observations are about the community and organizational preparations and planning for acute chemical hazard disasters. The results are drawn from data gathered on disaster preparedness in 14 communities and six major threats or actual disasters involving chemical agents in American society. A model for describing and analysing community and organizational disaster planning is outlined. Some initial observations are stated about how communities rank the probability of different kinds of disasters including chemical ones. We then present in general terms a series of findings about community and organizational perceptions and reactions with respect to chemical threats, resources to deal with such threats, the social organization of emergency related groups using such resources and the social climate in which the emergency groups operate. Some implications for planning are then indicated.