Immediate Aftermath Of Disaster Research Articles

Unique Challenges for WHO Emergency Medical Teams in Ukraine: Field Assessment & Global Recommendations.

The purpose of WHO Emergency Medical Teams is to Minor wording edit recommendations: 'to provide timely, high-quality health services.' (removed 'of') 'in the immediate aftermath of disasters and during disease outbreaks and other emergencies, including conflict and insecurity.'improve the timeliness and quality of health services by national and international Emergency Medical Teams in the immediate aftermath of a disaster, outbreak, and other emergencies, including war and conflicts. 'The war in Ukraine has presented all healthcare providers with many unique challenges'. What is meant by this? All Ukrainian HCPs, all HCP operating in Ukraine? Can you be more specific regarding what you are trying to say.The war in Ukraine has presented all healthcare providers with many unique challenges. This assessment addresses would edit to: 'the importance and the complexities of' the importance of and the complexities of the global spread of the Emergency Medical Team system challenges to meet a wide variety of crises including war, those that are unique to this very complex crisis in Ukraine, and the essential role of educational initiatives, not only in professional development but also in teamwork and cultural integration.

Disaster management with cloud-based geographic information systems: site selection of landfill areas after Kahramanmaraş, Türkiye earthquake sequence

On February 6, 2023, the earthquakes centered on Kahramanmaraş-Pazarcık and Kahramanmaraş-Elbistan affected several provinces in the region and generated a vast amount of demolition waste. This study aims to develop a site selection model for the most suitable landfill areas after the earthquake using open-source Geographic Information Systems (GIS) software and the Best-Worst Method (BWM). First, the study identifies decision criteria with a Delphi expert panel. Next, it determines the weights using the BWM based on pairwise comparison. Spatial data of the determinants were obtained from open data portals, and proximity, overlay, and slope analyses were carried out for the disaster region. Combining the output data layer of each criterion, a suitability map of the landfills was produced. As a result, 36,2% (29,826 kms square) of the study area was classified as suitable and very suitable. In this study, a cloud GIS-based decision support platform was developed to act quickly and initiate recovery processes within the scope of disaster management of the destructive earthquake. The suitability map and potential sites were shared with the responsible teams in the disaster area so that the potential sites could be displayed on the map and the suitable areas could be navigated on appropriate routes. The findings of the study revealed that the use of open data and cloud GIS framework in the disaster management process enables quick, reliable, and cost-effective actions in the immediate aftermath of disasters.

Psychological First Aid–Informed Guidelines for Mental Health Professionals Working With Central American Unaccompanied Minors in Transitional Settings

Abstract. News of unaccompanied minors (UMs) from Central America entering the United States–Mexico border have inundated political and social platforms as policies are discussed to address this crisis. The hope for a future away from violence, poverty, and fear drives these minors into embarking on an uncertain journey to the United States. The dangers these children encounter on their long travels along with previous distressing experiences from their home country put a devastating toll on their psychological and overall well-being. Their anguish continues as these youth are placed in transitional settings (i.e., shelters) while awaiting to be released into their new communities. While psychological care is often available at these settings, the complex realities of these children call for culturally and trauma-responsive guidelines to address their unique psychosocial needs. This conceptual paper reviews existent literature on the mental health needs of Central American youth in the United States–Mexico border as well as relevant theories and principles, such as the evidence-informed psychological first aid (PFA), which has shown to help Central American youth in the immediate aftermath of disasters and other crises. The aim of this manuscript was to adapt and expand on the core elements of PFA and utilize its theoretical basis to (1) enhance the psychological health of Central American UMs in transitional settings and (2) equip mental health professionals working in the United States–Mexican border or other US mental health professionals to address the immediate psychological needs of UMs from a culturally sensitive and trauma-informed approach.

Redefining shelter: humanitarian sheltering.

Shelter is one of the most 'intractable problems' in humanitarian aid and yet there is little clarity on an overarching definition. Terminology for shelter and housing is often conflated, and the most prominent definition does not fully reflect recent progress in the Shelter and Settlements Sector. This paper explores the varying terminology utilised in definitions of shelter within humanitarian aid since 1990, reflecting on the concepts of 'shelter' and 'housing', alongside surrounding perceptions of 'house' versus 'home', and related measures of adequacy. The current, most prolific definition is also deconstructed, demonstrating ambiguity in some of terminology such as 'dignity' and 'privacy', and revealing that interpretation of this definition depends on the reader's knowledge. Lastly, a new definition of 'sheltering' is proposed, encompassing five key reflections: the concept of process over object; the inclusion of communities and individuals; the commonality of long-term sheltering; the wider effects of shelter; and the impacts on host communities and environment.

Enabling Rapid Financial Response to Disasters: Knotting and Reknotting Multiple Paradoxes in Interorganizational Systems

While market-based solutions are increasingly being proposed to address major societal and development issues, they are also often considered antithetical to issues such as climate change, poverty alleviation and disaster response. In particular, the interorganizational systems involved in such market solutions gives rise to multiple contradictory tensions, known as paradoxes. We therefore adopt a paradox lens to explain the dynamics through which different actors within these systems navigate the contradictions that are generated. Drawing on a global qualitative study of multi-country risk pools that provide rapid capital in the immediate aftermath of disaster, we advance paradox theory by showing how organizational actors’ interactions i) maintain equilibrium by generating mutually reinforcing balance among paradoxes, whilst ii) the clustering of poles from different paradoxes generates disequilibrium, and iii) the reknotting of poles from different paradoxes restores equilibrium. As our process framework shows, these dynamics form an iterative cycle between equilibrium and disequilibrium that is essential in enhancing the promise of market-based solutions to address development issues; in our study increasing the rapid availability of capital to respond to disasters such as hurricanes, earthquakes and droughts.

The effects of earthquake exposure on preparedness in the short and long term: a difference-in-differences estimation

Emergency support is often delayed after a disaster. Despite the importance of being prepared to deal with the immediate aftermath of disasters, not everyone prepares effectively. While exposure to disasters improves people’s preparedness in the short term, it is yet to be determined whether this improvement is long lasting. In this paper, we use a difference-in-differences method to estimate the causal effects of the 2010 and 2011 Canterbury earthquakes on people’s preparedness in the short-term (1 month after the second earthquake) and long-term (up to 25 months after the second earthquake). Our results show that people who experienced the earthquakes increase their preparedness by 0.67 standard deviations in the short term. This impact stays positive, but declines to 0.42 standard deviations in the long term.

Ethical Considerations for Postdisaster Fieldwork and Data Collection in the Caribbean

The postdisaster environment presents a multitude of ethical and logistical challenges for researchers interested in gathering timely and unpreserved data. Due to the unavailability of secondary data in the immediate aftermath of disasters, postdisaster researchers have become dependent on qualitative methods that involve engaging with disaster survivors as research participants. This is a common interaction in the Caribbean due to the region’s high occurrence of disasters and human participant engagement by external researchers during the postdisaster phase. However, due to escalating unethical practices since the 2010 Haiti earthquake, Caribbean nations are beginning the process of censuring unapproved postdisaster fieldwork by external researchers. In this study, the authors approach these ethical considerations through a justice lens to propose a checklist for postdisaster researchers interested in ethical fieldwork and justice for their research participants. Correspondence with Caribbean emergency managers confirms the negative perception toward external researchers and the trend of enacting protocols that stop unvetted community access following disasters. However, these local agencies acknowledge the benefits of ethical postdisaster research and are open to serving as research coordinating centers. Such coordinating centers would harness local capabilities and lower the likelihood of the duplication of research topics and the overburdening of survivors as research participants.

Mass-Listening and the Diaspora: The Year in Puerto Rico

Mass-Listening and the DiasporaThe Year in Puerto Rico Ricia Anne Chansky (bio) Since the hurricane, I've been able to see that there is an incredible emotional need. It's up to us as individuals to try to fulfill this emotional need by listening. —Félix Serrano Villegas, San Juan1 We in Puerto Rico are now over two years from the successive landfalls of Hurricanes Irma and María in September 2017, and we still linger in a fraught aftermath. Looking beyond the sites photographed for glossy tourism campaigns reveals a different reality. Hospitals and schools remain closed, electricity and other utility services are precarious, and lasting instability combined with a dire lack of social services leave many citizens languishing in medical and mental health crises. The relief and rebuilding funds voted into existence by the United States Congress have yet to be fully released, leaving the majority of the $45.2 billion approved for disbursement sitting in an account instead of reaching people in need. In a more publicized aspect of this immoral—if not illegal—process, the US Department of Housing and Urban Development, better known as HUD, purposely missed the deadline to initiate the process for distributing billions of dollars' worth of relief funds earmarked for the archipelago. As I complete this essay, we are now in the midst of another disaster. An ongoing swarm of over 1,800 earthquakes has been recorded just off the southwestern coast of Puerto Rico, the largest to date registering at a magnitude of 6.4. This seismic activity is causing destruction on land and forcing thousands of Puerto Ricans to flee their homes for the "safety" of cars, streets, and tent cities. Locations far from the southwestern region are experiencing tremors, aftershocks, and power outages. This new disaster comes at a time when we are not yet anywhere near a recovery from the catastrophic hurricane season of 2017. The abysmal lack of government relief in the aftermaths of María has spawned population-wide anxiety, as many know all too well that we cannot rely upon local or national government [End Page 144] agencies for response, relief, or rebuilding. The layers of disaster are numerous and remain interwoven in our life stories—no matter how much time passes from the event—while the ways we narrate, disseminate, and receive life stories of disaster and its aftermaths are complex, nuanced, and endless. The invitation to contribute to an annual "International Year in Review" of narrated lives is especially helpful when it comes to noting patterns that signify phases of processing collective trauma. In the piece that I contributed to last year's feature, I explored narratives wrought in the urgency of the immediate aftermath of disaster. In this year's contribution, I will discuss briefly the production, circulation, and reception of Puerto Rican auto/biographical narratives over the past year in the contexts of what I call mass-listening projects. I define mass-listening projects as those that collect several life narratives related to a single issue or event for the purpose of curating multivoiced assemblages—in any modality or genre—for public dissemination. In other words, they are narrative transactions that have site-specific points for multiple speakers to conduct exchanges with multiple listeners.2 The reading witness or the act of receiving a disaster narrative is paramount to its function, as these life stories by their nature request forms of response, the most desired of which is action. In order to discuss a shift in diasporic identity constructions that I have observed since the hurricane, I will first examine a post on a Facebook page that I position as exemplary of this type of digital mass-listening project and then comment briefly upon three print anthologies as a means of extending my analysis of some of the ways this form of auto/biographical undertaking reshapes communal identity constructions that integrate home-space (experienced or imagined) with lived-space. I will focus on specific projects within digital and print publications to make larger arguments related to critical disaster studies, including the functions of diasporic communities, modes of narration, and listeners as witnesses to collective trauma. In the...

Short-Term Solutions to a Long-Term Challenge: Rethinking Disaster Recovery Planning to Reduce Vulnerabilities and Inequities.

In the immediate aftermath of disaster, governments usually act quickly to reduce risk and to recover their communities’ socio-economic functioning. Policy makers in these situations need—but may not have the capacity or time for—substantial analysis and public debate about how to balance short- and long-term societal needs. Inadequate attention to this challenge may result in a deepening of the inequities that increase vulnerability to disaster impacts. We review case examples to illustrate how post-disaster policies may influence the nature, pace, and inclusiveness of community recovery. We then apply a vulnerability/inequity framework to conceptualize how to enhance disaster recovery and avoid perpetuating inequities when weighing the diverse needs of communities across long time horizons.

Examining disaster preparedness at Matara District General Hospital in Sri Lanka

Globally, the frequency of natural disasters has increased significantly in recent decades. Hospitals are expected to remain functioning during and in the immediate aftermath of disasters as they are essential infrastructures in responding to them. Sri Lanka has experienced a number of natural disasters such as the tsunami of 2004, landslides and floods of 2017. Although the government has made some improvement mainly for infrastructure resiliency, inadequate disaster preparedness remains at many regional hospitals. Despite the critical role of hospitals in saving lives of disaster victims, very limited research has assessed disaster preparedness at hospitals in Sri Lanka. This study attempts to fill this gap by examining disaster preparedness at one district-level hospital in a disaster prone area. Field visits, phone interviews and an original questionnaire survey among doctors and nurses were conducted to better understand how they perceived the preparedness of this hospital. The results of the questionnaire survey revealed that most salient aspects of preparedness, such as human resources, communication, safety, security, transportation, critical supplies, and morgue capacity were inadequate. It also illustrated challenging areas in responding to a large number of disaster victims. Most of the respondents were unaware of the disaster response plan. Also, they had not participated in disaster drills. However, almost all the doctors and nurses demonstrated their willingness to improve their knowledge on disaster management and to serve in future disaster situations. This paper concludes with a number of recommendations to improve the disaster response capacity of Sri Lankan hospitals in the future.

Clinical Implications of Cultural Differences in Factors Influencing Resilience following Natural Disaster: A Narrative Review

PurposeIn the immediate aftermath of disasters, unaffected individuals and organisations attempt to help in whatever capacity may be available to them - including the provision of mental health interventions. It is therefore important to identify the mental health outcomes of such disaster in order for such help to target culturally appropriate interventions for these populations.ObjectiveThe objectives of this literature review were to identify and describe the mental health outcomes, interventions, and resilience or coping skills of survivors following natural disasters - namely earthquakes, hurricanes, tsunamis and floods -across different cultural settings.MethodsDue to the small number of studies identified, a narrative approach was employed to compile the data.ResultsTwelve studies were identified for this review and PTSD was the most common mental health outcome identified. Even though there were some differences in resilience and coping strategies of natural disaster survivors, on a micro-environmental level, social support appeared to be common. On a macro-systemic level, community factors, such as community services, cultural factors, spirituality and religion contributed to resilience across several cultures. However, mental health interventions adopted varied across different cultures.ConclusionMental health professionals can increase the extent to which they are viewed by victims as a viable source of assistance following a disaster by being aware of the impacts of culture and social class on mental health outcomes. Furthermore, targeting diversity among group members in the planning of disaster mental health services can likewise increase the trust with which diverse ethnic groups view mental health professionals. In essence, mental health professionals have to be innovative and think outside the box to meet the needs of disaster victims.

Psychosocial Influences on Disaster Preparedness in San Francisco Recipients of Home Care

Disasters disproportionately impact certain segments of the population, including children, pregnant women, people living with disabilities and chronic conditions and those who are underserved and under-resourced. One of the most vulnerable groups includes the community-dwelling elderly. Post-disaster analyses indicate that these individuals have higher risk of disaster-related morbidity and mortality. They also have suboptimal levels of disaster preparedness in terms of their ability to shelter-in-place or evacuate to a shelter. The reasons for this have not been well characterized, although impaired health, financial limitations, and social isolation are believed to act as barriers to preparedness as well as to adaptability to changes in the environment both during and in the immediate aftermath of disasters. In order to identify strategies that address barriers to preparedness, we recently conducted a qualitative study of 50 elderly home care recipients living in San Francisco. Data were collected during in-home, in-person interviews using a semi-structured interview guide that included psychosocial constructs based on the social cognitive preparedness model and a new 13-item preparedness checklist. The mean preparedness score was 4.74 (max 13, range 1-11, SD. 2.11). Over 60% of the participants reported that they had not made back-up plans for caregiver assistance during times of crisis, 74% had not made plans for transportation to a shelter, 56% lacked a back-up plan for electrical equipment in case of power outages, and 44% had not prepared an emergency contacts list-the most basic element of preparedness. Impairments, disabilities, and resource limitations served as barriers to preparedness. Cognitive processes that underlie motivation and intentions for preparedness behaviors were lacking. There were limitations with respect to critical awareness of hazards (saliency), self-efficacy, outcome expectancy, and perceived responsibility. There was also a lack of trust in response agencies and authorities and a limited sense of community. Participants wanted to be prepared and welcomed training, but physical limitations kept many of them home bound. Training of home care aides, the provision of needed resources, and improved community outreach may be helpful in improving disaster outcomes in this vulnerable segment of the population.

Responding to Catastrophe

Natural disasters often cause significant human suffering. They may also provide incentives for states to escalate repression against their citizens. We argue that state authorities escalate repression in the wake of natural disasters because the combination of increased grievances and declining state control produced by disasters creates windows of opportunity for dissident mobilization and challenges to state authority. We also investigate the impact of the post-disaster humanitarian aid on this relationship. Specifically, we argue that inflows of aid in the immediate aftermath of disasters are likely to dampen the impact of disasters on repression. However, we expect that this effect is greater when aid flows to more democratic states. We examine these interrelated hypotheses using cross-national data on immediate-onset natural disasters and state violations of physical integrity rights between 1977 and 2009 as well as newly collected foreign aid data disaggregated by sector. The results provide support for both our general argument and the corollary hypotheses.

“To silence the deafening silence”: Survivor's needs and experiences of the impact of disaster radio for their recovery after a natural disaster

In the aftermath of the Haiyan typhoon, disaster radio was used to spread information and music to the affected population. The study described survivors' experiences of being in the immediate aftermath of a natural disaster and the impact disaster radio made on recovery from the perspective of the individuals affected. Twenty eight survivors were interviewed in focus groups and individual interviews analyzed with phenomenological-hermeneutic method. Being in disaster mode included physical and psychosocial dimensions of being in the immediate aftermath of the disaster. Several needs among the survivors were expressed. Disaster radio contributed to recovery by providing facts and information that helped the survivor to understand and adapt. The music played contributed to emotional endurance and reduced feelings of loneliness. To re-establish social contacts, other interventions are needed. Disaster radio is a positive contribution to the promotion of survivors' recovery after disasters involving a large number of affected people and severely damaged infrastructure. Further studies on the use and impact of disaster radio are needed.

Earthquakes in Japan

AbstractThis review article examines three monographs that make conspicuous contributions to our understanding of major earthquake disasters in Japan from the mid-nineteenth century through to 2011. They focus on different events and different time periods, and ask different questions, but raise a host of shared issues relating to the on-going importance of disaster in Japan's history over the long term. They cause us to consider how seismic disaster is explained, understood, interpreted, and actualized in people's lives, how the risks are factored in, and how people respond to both immediate crisis and longer term consequences. One recurrent issue in these volumes is the extent to which these large natural disasters have the capacity to change—and actually do change—the ways in which societies organize themselves. In some cases disaster may be perceived as opportunity, but the evidence overwhelmingly suggests that a desire to return to the previous ‘normality’ is a powerful impulse in people's responses to major natural disasters. The review also argues that the issue of trust lies at the core of both individual and collective responses. A lack of trust may be most conspicuous in attitudes to government and elites, but is also inherent in more everyday personal interactions and market transactions in the immediate aftermath of disaster.

Assessment of Early Impact of Cyclone Thane on Physical and Psychosocial Environment

To the Editor: Disasters have the greatest effect on the most vulnerable groups, especially children [1–3]. Cyclone Thane hit the coast of Tamil Nadu and Pondicherry on 29th and 30th of December 2011 and destroyed houses, boats, standing crops, livestock and livelihoods. A questionnaire based study was conducted at JIPMER, Pondicherry 2 weeks after the cyclone to study its early impact of on the physical and psychosocial environment of children. Data including demographic parameters, feeding, damage to school and house, problems of electricity, water, transport, telecommunication and relief measures related to the disaster were collected in a structured proforma from 100 parentchild dyads from Thane affected areas. Likert scale (0–3) was used to quantify stress among parents and children. There was significant damage to home and schools secondary to falling of trees. Mean duration of return to normalcy for water supply, electricity and transport were 6.5, 10.8 and 3.2 d respectively. Cost of candles, kerosene and milk was significantly increased. Infants and young children were breastfed as usual and fed with the routine food items available at home during the first week after Thane. Only 35 % had used boiled water for drinking. Cow’s milk was not available for young children for 3–5 d after the disaster. No breastmilk substitutes (BMS) or feeding bottles were distributed. 39 % adults and 6 % children had minor illness which included 49 % upper respiratory tract infection, 33 % lower respiratory tract infection and 18% diarrhea. Significant level of stress was noted among parents and children. Disruption of water supply for more than 2 d and damage to house and school were significantly associated with parental stress. This study showed that Cyclone Thane had significant early impact on the physical and psychosocial environment of children. However, the long term effects including post traumatic stress disorder need to be assessed. Psychological first aid in the immediate aftermath of disaster may reduce the initial distress and foster short and long-term adaptive functioning [4]. Careful tracking of important health and mental health problems that confound recovery may lead to appropriate interventions that can help reduce morbidity associated with the inevitable next catastrophe [5].

2879 – Adaptation of a disaster mental health preparedness training model for black communities in the southeastern united states

Providing timely and accessible mental health services in the immediate aftermath of disasters remains a major challenge in under-resourced minority communities. We postulated that in black communities, successful strategies would require training both clinical providers and community leaders to collaboratively plan for and deliver culturally responsive disaster mental health services. We aimed to: 1) adapt an evidence-based, disaster mental health training model for black community leaders and clinical providers in under-resourced areas at risk of natural disasters, and 2) evaluate a train-the-trainer (TTT) model for building culturally-appropriate local mental health response capacity. We developed a core curriculum package based on a training needs assessment and resource review and then culturally tailored audience-specific workshop materials after pilot testing in eastern North Carolina. Pilot test participants included 13 community leaders and 10 clinical provider attending workshops facilitated by 3 mental health professionals. Evaluations indicated the workshop components were culturally relevant and post-test knowledge scores were generally higher among clinical providers. Process evaluation results have led to expanded content, a community planning session at 3 months, a refresher skills-building workshop at 6 months, training of trainers in facilitation skills, and tailoring of exercises to specific subpopulations. Field-testing with repeated outcome evaluation is underway in 8 culturally distinct coastal Carolina communities. Local relevance is critical to training acceptability and recruitment requires significant input from local community stakeholders. Evaluation of collaborative community engagement efforts and outcome evaluation will allow us to determine if this model is scalable and effective for under-resourced black community settings.

Practical Legal and Ethical Considerations for the Provision of Acute Disaster Mental Health Services

Mental health professionals who provide emergency psychosocial assistance in the immediate aftermath of disasters do so in the midst of crisis and chaos. Common roles undertaken by disaster mental health professionals include treating existing conditions of disaster survivors and providing psychosocial support to front line responders and those acutely affected. Other roles include participating in multidisciplinary health care teams as well as monitoring and supporting team members’ mental health. When, in the immediate aftermath of a disaster, mental health professionals provide such assistance, they may take on legal and ethical responsibilities that they are not fully aware of or do not fully comprehend. Unfortunately, not much has been written about these obligations, and professional organizations have provided little guidance. Thus, the purpose of the present article is to outline and discuss an analysis framework and suggest recommendations that mental health professionals can use to help guide their actions during the chaos immediate post disaster.

Can Mobile Phone Data Improve Emergency Response to Natural Disasters?

Disaster management requires accurate information and must link data collection and analysis to an immediate decision-making process. Existing approaches to assessing population movements in the immediate aftermath of disasters, such as transport surveys and manual registration of individuals at emergency-relief hubs, are often inadequate: while important for record-keeping purposes, both are slow and may exclude those groups who are unreachable and most vulnerable. Proxy analysis via aerial or even satellite reconnaissance has a potentially useful role, but can provide only a coarse geographical picture of moving populations. In practice, the most readily available sources of information are from eye-witness or media reports. Although timely, such reports are not accumulated systematically and can constitute a biased representation of events. Peter Gething and Andrew Tatem discuss the potential impact of mobile phone positioning data on disaster response and highlight challenges that must be addressed if use of this technology is to develop.

Trends of Elevated PTSD Risk in Firefighters Exposed to the World Trade Center Disaster: 2001–2005

We identified trends in the prevalence of elevated posttraumatic stress disorder (PTSD) risk as determined by the Fire Department of the City of New York (FDNY)-modified PTSD Checklist in World Trade Center (WTC)-exposed firefighters. We also examined trends in relation to WTC exposure, social support, change in recreational activities, and functional health. We analyzed 16,826 questionnaires from 10,074 firefighters in yearly intervals, from September 12, 2001, to September 11, 2005. The prevalence of elevated PTSD risk increased over time, from 9.8% in year 1 to 10.6% in year 4 (p < 0.0001). Earliest arrival at the WTC site (odds ratio [OR] = 6.0; 95% confidence interval [CI] 4.4, 8.3), prolonged work at the site (OR = 2.0; 95% CI 1.8, 2.3), providing supervision without previous supervisory experience (OR = 4.1; 95% CI 2.8, 6.1), and retirement due to a WTC-related disability (OR=1.3; 95% CI 1.1, 1.5) were associated with ever having elevated PTSD risk. Difficulty functioning at home was strongly associated with elevated PTSD risk (ORs ranged from 17.0 [95% CI 14.5, 20.0] in year 1 to 26.7 [95% CI 20.3, 35.2] in year 3), as was difficulty functioning at work (ORs ranged from 12.1 [95% CI 10.2, 14.2] in year 1 to 23.0 [95% CI 14.6, 36.3] in year 2). Elevated PTSD risk was associated with exposure to the WTC site as well as functional impairment, and remained largely unabated during the first four years of the study. Screening for elevated PTSD risk may be useful in identifying those who could benefit from interventions during long-term follow-up, as well as in the immediate aftermath of disasters.