Future Disaster Response Research Articles

Risk Factors for Depression Among Civilians After the 9/11 World Trade Center Terrorist Attacks: A Systematic Review and Meta-Analysis.

Introduction:The development of depressive symptoms among the population of civilians who were not directly involved in recovery or rescue efforts following the 9/11 World Trade Center (WTC) terrorist attacks is not comprehensively understood. We performed a meta-analysis that examined the associations between multiple risk factors and depressive symptoms after the 9/11 WTC terrorist attacks in New York City among civilians including survivors, residents, and passersby. Methods:PubMed, Google Scholar, and the Cochrane Library were searched from September, 2001 through July, 2016. Reviewers identified eligible studies and synthesized odds ratios (ORs) using a random-effects model.Results:The meta-analysis included findings from 7 studies (29,930 total subjects). After adjusting for multiple comparisons, depressive symptoms were significantly associated with minority race/ethnicity (OR, 1.40; 99.5% Confidence Interval [CI], 1.04 to 1.88), lower income level (OR, 1.25; 99.5% CI, 1.09 to 1.43), post-9/11 social isolation (OR, 1.68; 99.5% CI, 1.13 to 2.49), post-9/11 change in employment (OR, 2.06; 99.5% CI, 1.30 to 3.26), not being married post-9/11 (OR, 1.59; 99.5% CI, 1.18 to 2.15), and knowing someone injured or killed (OR, 2.02; 99.5% CI, 1.42 to 2.89). Depressive symptoms were not significantly associated with greater age (OR, 0.86; 99.5% CI, 0.70 to 1.05), no college degree (OR, 1.32; 99.5% CI, 0.96 to 1.83), female sex (OR, 1.24; 99.5% CI, 0.98 to 1.59), or direct exposure to WTC related traumatic events (OR, 1.26; 99.5% CI, 0.69 to 2.30). Discussion:Findings from this study suggest that lack of post-disaster social capital was most strongly associated with depressive symptoms among the civilian population after the 9/11 WTC terrorist attacks, followed by bereavement and lower socioeconomic status. These risk factors should be identified among civilians in future disaster response efforts.

Vulnerability factors of shellfisherwomen in the face of oil spill events: An analysis of the Prestige case

Increasingly frequent disasters involving oil spills in coastal zones highlight the vulnerability faced by women's groups that are highly dependent on the marine environment. Based on the theoretical contribution of feminist environmentalism and the interpretative approach of the pressure and release model (PAR model), this paper verifies the progressive vulnerability of Galician shellfisherwomen in the period prior to the 2002 Prestige disaster in Spain. The main findings reveal the marginal position occupied by shellfisherwomen within the fishing sector. Moreover, they demonstrate the shellfisherwomen's dependency on a fragile coastal zone constantly threatened by pollution yet lacking adequate protection measures. This combination of factors exposed the social-environmental system maintained by shellfisherwomen to the risk of an oil disaster, increasing the vulnerability of women in that region. This study employs a gender vulnerability analysis to better understand oil disasters, and makes recommendations to improve future disaster preparedness and response, thereby benefiting people at risk.

Monitoring and evaluation of disaster response efforts undertaken by local health departments: a rapid realist review

BackgroundLocal health departments are often at the forefront of a disaster response, attending to the immediate trauma inflicted by the disaster and also the long term health consequences. As the frequency and severity of disasters are projected to rise, monitoring and evaluation (M&E) efforts are critical to help local health departments consolidate past experiences and improve future response efforts. Local health departments often conduct M&E work post disaster, however, many of these efforts fail to improve response procedures.MethodsWe undertook a rapid realist review (RRR) to examine why M&E efforts undertaken by local health departments do not always result in improved disaster response efforts. We aimed to complement existing frameworks by focusing on the most basic and pragmatic steps of a M&E cycle targeted towards continuous system improvements. For these purposes, we developed a theoretical framework that draws on the quality improvement literature to ‘frame’ the steps in the M&E cycle. This framework encompassed a M&E cycle involving three stages (i.e., document and assess, disseminate and implement) that must be sequentially completed to learn from past experiences and improve future disaster response efforts. We used this framework to guide our examination of the literature and to identify any context-mechanism-outcome (CMO) configurations which describe how M&E may be constrained or enabled at each stage of the M&E cycle.ResultsThis RRR found a number of explanatory CMO configurations that provide valuable insights into some of the considerations that should be made when using M&E to improve future disaster response efforts. Firstly, to support the accurate documentation and assessment of a disaster response, local health departments should consider how they can: establish a culture of learning within health departments; use embedded training methods; or facilitate external partnerships. Secondly, to enhance the widespread dissemination of lessons learned and facilitate inter-agency learning, evaluation reports should use standardised formats and terminology. Lastly, to increase commitment to improvement processes, local health department leaders should possess positive leadership attributes and encourage shared decision making.ConclusionThis study is among the first to conduct a synthesis of the CMO configurations which facilitate or hinder M&E efforts aimed at improving future disaster responses. It makes a significant contribution to the disaster literature and provides an evidence base that can be used to provide pragmatic guidance for improving M&E efforts of local health departments.Trial registrationPROSPERO 2015:CRD42015023526.

Setting Foundations for Developing Disaster Response Metrics.

There are few reported efforts to define universal disaster response performance measures. Careful examination of responses to past disasters can inform the development of such measures. As a first step toward this goal, we conducted a literature review to identify key factors in responses to 3 recent events with significant loss of human life and economic impact: the 2003 Bam, Iran, earthquake; the 2004 Indian Ocean tsunami; and the 2010 Haiti earthquake. Using the PubMed (National Library of Medicine, Bethesda, MD) database, we identified 710 articles and retained 124 after applying inclusion and exclusion criteria. Seventy-two articles pertained to the Haiti earthquake, 38 to the Indian Ocean tsunami, and 14 to the Bam earthquake. On the basis of this review, we developed an organizational framework for disaster response performance measurement with 5 key disaster response categories: (1) personnel, (2) supplies and equipment, (3) transportation, (4) timeliness and efficiency, and (5) interagency cooperation. Under each of these, and again informed by the literature, we identified subcategories and specific items that could be developed into standardized performance measures. The validity and comprehensiveness of these measures can be tested by applying them to other recent and future disaster responses, after which standardized performance measures can be developed through a consensus process. (Disaster Med Public Health Preparedness. 2017;11:505-509).

Effects of a major disaster on skills shortages in the construction industry

PurposeThe purpose of this paper is to empirically investigate the effects of a major disaster on the management of human resources in the construction sector. It sets out to identify the construction skills challenges and the factors that affected skills availability following the 2010/2011 earthquakes in Christchurch. It is hoped that this study will provide insights for on-going reconstruction and future disaster response with respect to the problem of skills shortages.Design/methodology/approachA triangulation method was adopted. The quantitative method, namely, a questionnaire survey, was employed to provide a baseline description. Field observations and interviews were used as a follow-up to ascertain issues and potential shortages over time. Three focus groups in the form of research workshops were convened to gain further insight into the feedback and to investigate the validity and applicability of the research findings.FindingsThe earthquakes in Christchurch had compounded the pre-existing skills shortages in the country due to heightened demand from reconstruction. Skills shortages primarily existed in seismic assessment and design for land and structures, certain trades, project management and site supervision. The limited technical capability available nationally, shortage of temporary accommodation to house additional workers, time needed for trainees to become skilled workers, lack of information about reconstruction workloads and lack of operational capacity within construction organisations, were critical constraints to the resourcing of disaster recovery projects.Research limitations/implicationsThe research findings contribute to the debate on skills issues in construction. The study provides evidence that contributes to an improved understanding of the industry’s skills vulnerability and emerging issues that would likely exist after a major disaster in a resource-limited country such as New Zealand.Practical implicationsFrom this research, decision makers and construction organisations can gain a clear direction for improving the construction capacity and capability for on-going reconstruction. Factors that affected the post-earthquake skills availability can be considered by decision makers and construction organisations in their workforce planning for future disaster events. The recommendations will assist them in addressing skills shortages for on-going reconstruction.Originality/valueAlthough the study is country-specific, the findings show the nature and scale of skills challenges the construction industry is likely to face following a major disaster, and the potential issues that may compound skills shortages. It provides lessons for other disaster-prone countries where the resource pool is small and a large number of additional workers are needed to undertake reconstruction.

Hurricane Maria, personal and collective suffering, and psychosocial support as a cross-cutting intervention

Here we discuss the role of psychosocial support activities in the immediate aftermath of Hurricane Maria in Puerto Rico. We report comments from 630 survivors from 22 towns. The focus is given to reactions, risk factors and resilience. The responses of the survivors were divided into individual and community losses. We propose that the response to such a catastrophic event was psychosocial and give suggestions for psychosocial support during future disaster responses.

Digitally enabled disaster response: the emergence of social media as boundary objects in a flooding disaster

AbstractIn recent times, social media has been increasingly playing a critical role in response actions following natural catastrophes. From facilitating the recruitment of volunteers during an earthquake to supporting emotional recovery after a hurricane, social media has demonstrated its power in serving as an effective disaster response platform. Based on a case study of Thailand flooding in 2011 – one of the worst flooding disasters in more than 50 years that left the country severely impaired – this paper provides an in‐depth understanding on the emergent roles of social media in disaster response. Employing the perspective of boundary object, we shed light on how different boundary spanning competences of social media emerged in practice to facilitate cross‐boundary response actions during a disaster, with an aim to promote further research in this area. We conclude this paper with guidelines for response agencies and impacted communities to deploy social media for future disaster response.

The Department of Defense at the Forefront of a Global Health Emergency Response: Lessons Learned from the Ebola Outbreak

Tasked with analyzing the effectiveness of the Department of Defense's (DoD's) global health engagements, the Uniformed Services University of the Health Sciences (USU) used the Measures Of Effectiveness in Defense Engagement and Learning (MODEL) study to conduct a qualitative analysis of the DoD's response efforts to the Ebola pandemic in West Africa. The research aims to summarize the findings of studies that monitor and evaluate the DoD's response to the Ebola pandemic or compare the effectiveness of different DoD response activities; it further aims to identify common themes around positive and negative lessons learned and recommendations that can be applied to future DoD humanitarian assistance and disaster response efforts. The search included documents and observations from PubMed, Disaster Lit: Resource Guide for Disaster Medicine and Public Health, the Joint Lessons Learned Information System, the DoD and US Africa Command websites, and Google Scholar. The records selected from the search were analyzed to provide insights on the DoD's humanitarian assistance and disaster response engagements that could be employed to inform future operations and policy. Furthermore, the research identifies strengths and gaps in military capabilities to respond to disasters, which can be used to inform future training and education courses. Overall, the findings demonstrate the importance of monitoring, evaluating, and assessing disaster response activities and provide new evidence to support the implementation of activities, in accordance with the Global Health Security Agenda, to strengthen all-threat prevention, detection, and response capabilities worldwide.

Off the rails in rural South Carolina: a qualitative study of healthcare provider perspectives on the long-term health impact of the Graniteville train disaster

In 2005, a train derailment and subsequent chlorine spill ravaged the rural town of Graniteville in South Carolina, resulting in one of the worst chlorine gas exposures in US. Significant health and economic challenges persist in the community more than a decade later. Healthcare providers offered healthcare services to community members in the immediate aftermath of the disaster, and many still live in the community and continue to provide healthcare services. As such, healthcare professionals provide a unique and important perspective to help understand the impact of the disaster on the community's health. The purpose of this study was to explore healthcare providers' perspectives about the long-term effects of the disaster on community health, healthcare access, and wellbeing. Semi-structured interviews were conducted with 30 healthcare providers who treated survivors of the Graniteville train disaster. A qualitative, essentialist, inductive thematic analytic approach was used to analyze study data. Four themes emerged regarding the disaster's long-term impact: effects of chlorine exposure on physical health, issues with healthcare access, residual effects of the disaster on personal and community wellbeing, and improving health and community wellbeing. Disaster recovery should not be considered solely an acute event; agencies must be prepared for long-term, potentially chronic ailments, particularly in underserved, rural communities. Efforts to address the long-term health needs of communities post-disaster should consider the perspectives of healthcare providers to offer a well-rounded assessment of community needs. Study findings can help inform future disaster response strategies in communities locally and globally.

Lava flow hazard at Fogo Volcano, Cabo Verde, before and after the 2014–2015 eruption

Abstract. Lava flow simulations help to better understand volcanic hazards and may assist emergency preparedness at active volcanoes. We demonstrate that at Fogo Volcano, Cabo Verde, such simulations can explain the 2014–2015 lava flow crisis and therefore provide a valuable base to better prepare for the next inevitable eruption. We conducted topographic mapping in the field and a satellite-based remote sensing analysis. We produced the first topographic model of the 2014–2015 lava flow from combined terrestrial laser scanner (TLS) and photogrammetric data. This high-resolution topographic information facilitates lava flow volume estimates of 43.7 ± 5.2 × 106 m3 from the vertical difference between pre- and posteruptive topographies. Both the pre-eruptive and updated digital elevation models (DEMs) serve as the fundamental input data for lava flow simulations using the well-established DOWNFLOW algorithm. Based on thousands of simulations, we assess the lava flow hazard before and after the 2014–2015 eruption. We find that, although the lava flow hazard has changed significantly, it remains high at the locations of two villages that were destroyed during this eruption. This result is of particular importance as villagers have already started to rebuild the settlements. We also analysed satellite radar imagery acquired by the German TerraSAR-X (TSX) satellite to map lava flow emplacement over time. We obtain the lava flow boundaries every 6 to 11 days during the eruption, which assists the interpretation and evaluation of the lava flow model performance. Our results highlight the fact that lava flow hazards change as a result of modifications of the local topography due to lava flow emplacement. This implies the need for up-to-date topographic information in order to assess lava flow hazards. We also emphasize that areas that were once overrun by lava flows are not necessarily safer, even if local lava flow thicknesses exceed the average lava flow thickness. Our observations will be important for the next eruption of Fogo Volcano and have implications for future lava flow crises and disaster response efforts at basaltic volcanoes elsewhere in the world.

Republic of Senegal Disaster Preparedness and Response Exercise: Lessons Learned and Progress Toward Key Goals.

The Republic of Senegal Disaster Preparedness and Response Exercise was held from June 2-6, 2014, in Dakar, Senegal. The goal was to assist in familiarizing roles and responsibilities within 3 existing plans and to update the National Disaster Management Strategic Work Plan. There were 60 participants in the exercise, which was driven by a series of evolving disaster scenarios. During the separate Disaster Management Strategic Work Plan review, participants refined a list of projects, including specific tasks to provide a "road map" for completing each project, project timelines, and estimated resource requirements. Project staff administered a survey to conference participants. A total of 86% of respondents had improved knowledge of Senegal disaster plans as a result of the exercise. A total of 89% of respondents had a better understanding of their ministry's role in disaster response, and 92% had a better understanding of the role of the military during a pandemic. Participants also generated ideas for disaster management system improvement in Senegal through a formal "gap analysis." Participants were in strong agreement that the exercise helped them to better understand the contents of their disaster response plans, build relationships across ministerial lines, and effectively enhance future disaster response efforts. (Disaster Med Public Health Preparedness. 2017;11:183-189).

What Happened to Our Environment and Mental Health as a Result of Hurricane Sandy?

This study describes findings of the impacts of Hurricane Sandy on environmental factors including power outages, air quality, water quality, and weather factors and how these affected mental health during the hurricane. An ecological study was conducted at the county level to describe changes in environmental factors-especially power outages-and their relationships to emergency department (ED) visits for mental health problems by use of a Poisson regression model. We found that many environmental hazards occurred as co-exposures during Hurricane Sandy in addition to flooding. Mental health ED visits corresponded with the peak of maximum daily power blackouts, with a 3-day lag, and were positively associated with power blackouts in Bronx (prevalence ratio [PR]: 8.82, 95% confidence interval [CI]: 1.27-61.42) and Queens (PR: 2.47, 95% CI: 1.05-5.82) counties. A possible dose-response relationship was found between the quantile of maximum blackout percentage and the risk of mental health in the Bronx. We found that multiple co-environmental hazards occurred during Hurricane Sandy, especially power blackouts that mediated this disaster's impacts. The effects of power outage on mental health had large geographic variations and were substantial, especially in communities with low sociodemographic status. These findings may provide new insights for future disaster response and preparedness efforts. (Disaster Med Public Health Preparedness. 2016;10:314-319).

Current Issues Regarding the Incident Command System in the Philippines

The First Association of Southeast Asian Nations (ASEAN) Committee on Disaster Management Meeting established a framework for ASEAN-US cooperation on the Disaster Management Program in 2003, focusing on capability building for the Incident Command System (ICS). The ICS was then adopted as part of the on-scene disaster response system in the Republic of the Philippines as enacted by the Philippine Disaster Risk Reduction and Management Act in 2010. This study investigates the process of adopting the ICS, its current status, and future issues through interview surveys of local and national governments in the Philippines. After adopting and implementing of the ICS as the national disaster response system for the Philippines is investigated, the current status of the ICS at the local government level is surveyed in a flood-prone area of the Pampanga River basin in central Luzon. Results show that the ICS has been adopted on all levels of government – national, regional, provincial, municipal, and barangay, i.e., the country’s smallest administrative division. Each local government level has incorporated the ICS into its contingency plan. Several issues related to future disaster response planning and capacity building are then reviewed.

Integration of energy analytics and smart energy microgrid into mobile medicine operations for the 2012 Democratic National Convention.

Disasters create major strain on energy infrastructure in affected communities. Advances in microgrid technology offer the potential to improve "off-grid" mobile disaster medical response capabilities beyond traditional diesel generation. The Carolinas Medical Center's mobile emergency medical unit (MED-1) Green Project (M1G) is a multi-phase project designed to demonstrate the benefits of integrating distributive generation (DG), high-efficiency batteries, and "smart" energy utilization in support of major out-of-hospital medical response operations. Carolinas MED-1 is a mobile medical facility composed of a fleet of vehicles and trailers that provides comprehensive medical care capacities to support disaster response and special-event operations. The M1G project partnered with local energy companies to deploy energy analytics and an energy microgrid in support of mobile clinical operations for the 2012 Democratic National Convention (DNC) in Charlotte, North Carolina (USA). Energy use data recorded throughout the DNC were analyzed to create energy utilization models that integrate advanced battery technology, solar photovoltaic (PV), and energy conservation measures (ECM) to improve future disaster response operations. The generators that supply power for MED-1 have a minimum loading ratio (MLR) of 30 kVA. This means that loads below 30 kW lead to diesel fuel consumption at the same rate as a 30 kW load. Data gathered from the two DNC training and support deployments showed the maximum load of MED-1 to be around 20 kW. This discrepancy in MLR versus actual load leads to significant energy waste. The lack of an energy storage system reduces generator efficiency and limits integration of alternative energy generation strategies. A storage system would also allow for alternative generation sources, such as PV, to be incorporated. Modeling with a 450 kWh battery bank and 13.5 kW PV array showed a 2-fold increase in potential deployment times using the same amount of fuel versus the current conventional system. The M1G Project demonstrated that the incorporation of a microgrid energy management system and a modern battery system maximize the MED-1 generators' output. Using a 450 kWh battery bank and 13.5 kW PV array, deployment operations time could be more than doubled before refueling. This marks a dramatic increase in patient care capabilities and has significant public health implications. The results highlight the value of smart-microgrid technology in developing energy independent mobile medical capabilities and expanding cost-effective, high-quality medical response.

Participatory Mapping Approaches to Coordinate the Emergency Response of Spontaneous Volunteers After Hurricane Sandy

This article demonstrates the potential of participatory mapping approaches to coordinate spontaneous volunteers and assist government agencies and humanitarian organizations in emergency contexts. The research focuses on one case study of a volunteer mapping project in the Rockaways in New York City to help communicate the needs reported by community members to outsiders after Hurricane Sandy. The map proved to be helpful in the coordination of relief efforts by volunteers and in understanding the variety of groups involved in emergency response. However, the map could not be sustained for long-term community recovery. The research offers new evidence of the potential contributions of spontaneous volunteers that can be leveraged, replicated and improved upon for future disaster planning and response. It also highlights the importance of volunteered geographic information in ensuring that emergency response is guided by the needs reported by citizens themselves, even if they do not have access to technology.

Dynamic Temperature and Humidity Environmental Profiles: Impact for Future Emergency and Disaster Preparedness and Response

During disasters and complex emergencies, environmental conditions can adversely affect the performance of point-of-care (POC) testing. Knowledge of these conditions can help device developers and operators understand the significance of temperature and humidity limits necessary for use of POC devices. First responders will benefit from improved performance for on-site decision making. To create dynamic temperature and humidity profiles that can be used to assess the environmental robustness of POC devices, reagents, and other resources (eg, drugs), and thereby, to improve preparedness. Surface temperature and humidity data from the National Climatic Data Center (Asheville, North Carolina USA) was obtained, median hourly temperature and humidity were calculated, and then mathematically stretched profiles were created to include extreme highs and lows. Profiles were created for: (1) Banda Aceh, Indonesia at the time of the 2004 Tsunami; (2) New Orleans, Louisiana USA just before and after Hurricane Katrina made landfall in 2005; (3) Springfield, Massachusetts USA for an ambulance call during the month of January 2009; (4) Port-au-Prince, Haiti following the 2010 earthquake; (5) Sendai, Japan for the March 2011 earthquake and tsunami with comparison to the colder month of January 2011; (6) New York, New York USA after Hurricane Sandy made landfall in 2012; and (7) a 24-hour rescue from Hawaii USA to the Marshall Islands. Profiles were validated by randomly selecting 10 days and determining if (1) temperature and humidity points fell inside and (2) daily variations were encompassed. Mean kinetic temperatures (MKT) were also assessed for each profile. Profiles accurately modeled conditions during emergency and disaster events and enclosed 100% of maximum and minimum temperature and humidity points. Daily variations also were represented well with 88.6% (62/70) of temperature readings and 71.1% (54/70) of relative humidity readings falling within diurnal patterns. Days not represented well primarily had continuously high humidity. Mean kinetic temperature was useful for severity ranking. Simulating temperature and humidity conditions clearly reveals operational challenges encountered during disasters and emergencies. Understanding of environmental stresses and MKT leads to insights regarding operational robustness necessary for safe and accurate use of POC devices and reagents. Rescue personnel should understand these principles before performing POC testing in adverse environments.

Lessons from disaster: the power and place of story

Purpose – The purpose of this paper is to view the human experiences of the Canterbury earthquakes through a varied set of disciplinary lenses in order to give voice to those who experienced the trauma of the earthquakes, especially groups whose voices might not otherwise be heard. Design/methodology/approach – The research designs represented in this special issue and discussed in this introductory paper cover the spectrum from open-ended qualitative approaches to quantitative survey design. Data gathering methods included video and audio interviews, observations, document analysis and questionnaires. Data were analysed using thematic, linguistic and statistical tools. Findings – The themes discussed in this introductory paper highlight that the Canterbury response and recovery sequence follows similar phases established in other settings such as Hurricane Katrina and the Australian bushfires. The bonding role of community networks was shown to be important, as was the ability to adapt formal and informal leadership to manage crisis situations. Finally, the authors reinforce the important protocols to follow when researching in sensitive contexts. Research limitations/implications – The introductory paper only discusses the articles in this special issue but it is important to acknowledge that there are other groups whose stories were not shared due to logistical limitations. Originality/value – This introductory paper sets the scene for the articles that follow by outlining the importance of the human stories of the Canterbury earthquakes, through the eyes of particular groups, for example, medical staff, schools, women, children and refugees. The approach of viewing the experience through different community voices and disciplinary lenses is novel and significant. The lessons that are shared will inform future disaster preparedness, response and recovery policy and planning.

Disaster impact across cultural groups: comparison of Whites, African Americans, and Latinos.

The current study extends knowledge regarding the differential impact of natural disasters among White, African American, and Latino survivors of Hurricane Ike through its use of a large, regional sample recruited via representative sampling procedures to examine the associations between cultural identification and disaster impact, including loss, damage, and negative mental health outcomes. Consistent with previous research, results indicated disparities between cultural groups with regard to disaster exposure. Additionally, type of disaster impact was differentially associated with PTSD and depression status dependent on cultural group. Specifically, the extent of personal disaster exposure, property damage, and loss of services made significant contributions to PTSD status among White survivors. African-Americans were more likely than White and Latino Ike survivors to endorse post-disaster PTSD and depression and endorsement of depression was predicted by severity of property damage. With respect to Latino respondents, only the extent of personal disaster exposure significantly contributed to both PTSD and depression status. Implications of the current findings are discussed with regard to future disaster preparedness and response efforts and the implementation and evaluation of community-based disaster resources.

Haitian Earthquake Relief: Disaster Response Aboard theUSNS Comfort

The Haitian earthquake of January 12, 2010, was a disaster essentially unprecedented in the Western Hemisphere's recorded history. The USNS Comfort departed from Baltimore, Maryland, within 72 hours of the earthquake and arrived in Port-au-Prince harbor on January 19. During the subsequent 40 days, the ship provided one of the largest relief efforts in the US Navy's history. The data analyzed included all patients evaluated and treated by the USNS Comfort between January 19 and February 27, 2010. A medical chart with a unique identifier was created for each patient on admission. A patient database was created from these records and used for this analysis. A total of 872 patients and 185 patient escorts were processed aboard the ship. Ages ranged from younger than 1 day to 89 years: 635 were adults and 237 were children. Of those admitted, 817 of the patients were admitted for longer than 24 hours; the average length of stay was 8.0 days. The need for surgery was substantial: 454 patients went to the operating room (OR) 843 times for 927 cumulative procedures. A total of 58 patients underwent amputations. Haiti was almost completely reliant on foreign medical teams for trauma care. Analysis of the data illustrates the challenges of triage and treatment in a humanitarian mass-casualty response. The remarkable coordination and cooperation among the Haitian Ministry of Health, nongovernmental humanitarian aid organizations, and the US military highlighted the responders' respective capabilities and demonstrated the importance of collaboration in future disaster response efforts.

The transmission of information in the immediate aftermath of the great East Japan earthquake by the administration in their efforts to establish safe communities

BackgroundThis survey examines the availability of information in the aftermath of the Great East Japan Earthquake in X City, which was affected by the disaster, and considers future disaster response...