Art of Disaster Preparedness in European Union: a Survey on the Health Systems

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Introduction: Naturally occurring and man-made disasters have been increasing in the world, including Europe, over the past several decades. Health systems are a key part of any community disaster management system. The success of preparedness and prevention depends on the success of activities such as disaster planning, organization and training. The aim of this study is to evaluate health system preparedness for disasters in the 27 European Union member countries.

Method: A cross-sectional analysis study was completed between June-September 2012. The checklist used for this survey was a modified from the World Health Organization toolkit for assessing health-system capacity for crisis management. Three specialists from each of the 27 European Union countries were included in the survey. Responses to each survey question were scored and the range of preparedness level was defined as 0-100%, categorized in three levels as follows: Acceptable; Transitional; or Insufficient.

Results: Response rate was 79.1%. The average level of disaster management preparedness in the health systems of 27 European Union member states was 68% (Acceptable). The highest level of preparedness was seen in the United Kingdom, Luxemburg, and Lithuania. Considering the elements of disaster management system, the highest level of preparedness score was at health information elements (86%), and the lowest level was for hospitals, and educational elements (54%).

Conclusion: This survey study suggests that preparedness level of European Union countries in 2012 is at an acceptable level but could be improved. Elements such as hospitals and education and training suffer from insufficient levels of preparedness. The European Union health systems need a collective strategic plan, as well as enough resources, to establish a comprehensive and standardized disaster management strategy plan. A competency based training curriculum for managers and first responders is basic to accomplishing this goal.

Keywords: Disaster medicine; Disaster preparedness; Disaster epidemiology; Health systems; European Union

Validating Indicators of Disaster Recovery with Qualitative Research

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Introduction: Recovery from disasters is a critical function of federal, state, and local governments, yet measurable, validated indicators of community recovery remain unidentified. A list of potential recovery indicators was developed by the authors through a literature review, recovery plan review, and case study of two disaster impacted communities.

Methods: To validate the indicators, qualitative data was collected from experts on disaster recovery. Twenty-one key informant interviews and two focus groups were conducted between January and April of 2014 to solicit feedback from disaster recovery practitioners and academics.

Results: Five major themes emerged from the qualitative data. These included: the flexibility of the indicators to serve multiple purposes for communities and individuals both pre- and post- disaster; the focus areas are comprehensive, but content and organization can be improved; the importance of seeing the indicators as a self-assessment, rather than a tool for comparing communities; the potential challenges of collecting data for some indicators; and the identification of potential measurement issues with the indicators.

Discussion: The proposed recovery indicators can be utilized by both practitioners and researchers to effectively track post-disaster recovery. They capture many of the complexities of community disaster recovery and provide potential opportunities for linkages to the development of disaster recovery plans and other activities that could increase community resilience in the future.

Communicable Diseases Surveillance System in East Azerbaijan Earthquake: Strengths and Weaknesses

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Background: A Surveillance System was established for 19 diseases/syndromes in order to prevent and control communicable diseases after 2012 East Azerbaijan earthquakes. This study was conducted to investigate the strengths and weaknesses of the established SS.

Methods: This study was carried out on an interview-based qualitative study using content analysis in 2012. Data was collected by semi-structured deep interviews and surveillance data. Fifteen interviews were conducted with experts and health system managers who were engaged in implementing the communicable disease surveillance system in the affected areas. The selection of participants was purposeful. Data saturation supported the sample size. The collected data was analyzed using the principles suggested by Strauss and Corbin.

Results: Establishment of the disease surveillance system was rapid and inexpensive. It collected the required data fast. It also increased confidence in health authorities that the diseases would be under control in earthquake-stricken regions. Non estimated denominator for calculating the rates (incidence & prevalence), non-participation of the private sector and hospitals, rapid turnover of health staff and unfamiliarity with the definitions of the diseases were the weak points of the established disease SS.

Conclusion: During the time when surveillance system was active, no significant outbreak of communicable diseases was reported. However, the surveillance system had some weaknesses. Thus, considering Iran’s susceptibility to various natural hazards, repeated exercises should be conducted in the preparedness phase to decrease the weaknesses. In addition, other types of surveillance system such as web-based or mobile-based systems should be piloted in disaster situations for future.

Variables Associated with Effects on Morbidity in Older Adults Following Disasters

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Introduction: Older adults are vulnerable to disproportionately higher morbidity following disasters. Reasons for this vulnerability are multifaceted and vary by disaster type as well as patient comorbidities. Efforts to mitigate this increased morbidity require identification of at-risk older adults who can be targeted for intervention.

Methods: A PubMed search was performed using the search terms “geriatric, disaster” and “morbidity, disaster” to identify published articles that reported variables associated with increased morbidity of older adults during and after disasters. A review of article titles and abstracts was then conducted to identify those articles that contained evidence-based variables that render older adults vulnerable to poor health outcomes during disasters.

Results: A total of 233 studies was initially identified. After applying exclusion criteria, nine studies were chosen for the comprehensive review. Based on the synthesis of the literature, factors were identified that were repeatedly associated with morbidity and mortality among older adults during and shortly after disasters.

Conclusion: Older adults, especially those with multiple co-morbidities, are at risk of increased morbidity after disasters and catastrophic events. Factors such as the need for prescription medications, low social support, visual and hearing impairment, impaired mobility, and poor economic status are associated with an increased risk of morbidity.

The Race to Save Lives: Demonstrating the Use of Social Media for Search and Rescue Operations

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Importance: Utilizing social media in an emergency can enhance abilities to locate and evacuate casualties more rapidly and effectively, and can contribute towards saving lives following a disaster, through better coordination and collaboration between search and rescue teams.

Objective: An exercise was conducted in order to test a standard operating procedure (SOP) designed to leverage social media use in response to an earthquake, and study whether social media can improve joint Israeli-Jordanian search and rescue operations following a regional earthquake.

Design: First responders from both Jordan and Israel were divided into two mixed groups of eight people each, representing joint (Israeli-Jordanian) EMS teams. Simulated patients were dispersed throughout the Ben-Gurion University Campus. The first search and rescue team used conventional methods, while the second team also used social media channels (Facebook and Twitter) to leverage search and rescue operations.

Participants: Eighteen EMS and medical professionals from Israel and Jordan, which are members of the Emergency Response Development and Strategy Forum working group, participated in the exercise.

Results: The social media team found significantly more mock casualties, 21 out of 22 (95.45%) while the no-media team found only 19 out of 22 (86.36%). Fourteen patients (63.63%) were found by the social media team earlier than the no-media team. The differences between the two groups were analyzed using the Mann-Whitney U-test, and evacuation proved to be significantly quicker in the group that had access to social media. The differences between the three injury severities groups’ extraction times in each group were analyzed using the Kruskal-Wallis test for variance. Injury severity influenced the evacuation times in the social media team but no such difference was noted in the no-media team.

Conclusions: Utilizing social media in an emergency situation enables to locate and evacuate casualties more rapidly and effectively. Social media can contribute towards saving lives during a disaster, in national and bi-national circumstances. Due to the small numbers in the groups, this finding requires further verification on a larger study cohort.

Challenges for Resuming Normal Life After Earthquake: A Qualitative Study on Rural Areas of Iran

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Background and objective:
Growing evidence is indicating that some of disaster affected people face challenges to resume normal life several months after an earthquake. However, there is no sufficient in-depth understanding of complex process of resuming normal life after an earthquake in Iran, as one of the most disaster-prone countries in the world, and in rural areas as a particular setting. This study aimed to explore challenges of return to normalcy in rural earthquake-stricken areas of Iran.

Methods:
The study was conducted using qualitative content analysis method (Graneheim approach). Twenty people from the earthquake-stricken areas and seven qualified experts were selected via purposeful sampling .Data was collected through semi-structured interviews, focus group discussions, and field notes from August 2013 to January 2014. Data collection continued to the point of data saturation (no new information was provided by interviewees). Data saturation supported the sample size. Data analysis was based on qualitative content analysis principles.

Results:
“Social uncertainty and confusion” was the most prominent challenge of return to the normal life after earthquake, which was categorized into six concepts of social vulnerability, lack of comprehensive rehabilitation plan, incomplete reconstruction, ignorance of local social capital, waste of assets, and psychological problems.

Conclusions:
Findings showed that social uncertainty and confusion occurs as a result of negligence of some important social aspects in process of returning to the normal life. This issue, in turn, can greatly interrupt the normal developmental processes. Understanding the challenges of life recovery after disasters will help policy makers consider social rehabilitation as a key factor in facilitation of return to normal life process after earthquakes.

Keywords: Disaster; earthquake; social rehabilitation; social uncertainty.

Patient Reactions after the Canterbury Earthquakes 2010-11: A Primary Care Perspective

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Aim – To explore GP perceptions of the impact of the 2010/2011 Canterbury earthquakes on primary care clinic patients.

Methods – Qualitative study using semi-structured interviews with eight GPs from the Christchurch area exploring GPs’ perceptions of the impact on patients.

Results – Patients experienced significant strain and anxiety following the earthquakes. The impact of this differed due to personal circumstances. Secondary stressors such as insurance and housing issues contributed to experiences of distress.

Conclusions – The GPs identified significant impacts on patients as a result of the earthquakes with significant levels of strain and anxiety being due to the on-going recovery process. It appears that a significant proportion of the affected population felt comfortable talking with the GPs about the earthquakes, secondary stressors and their effects upon them.

The EnRiCH Community Resilience Framework for High-Risk Populations

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Introduction: Resilience has been described in many ways and is inherently complex. In essence, it refers to the capacity to face and do well when adversity is encountered. There is a need for empirical research on community level initiatives designed to enhance resilience for high-risk groups as part of an upstream approach to disaster management. In this study, we address this issue, presenting the EnRiCH Community Resilience Framework for High-Risk Populations.

Methods: The framework presented in this paper is empirically-based, using qualitative data from focus groups conducted as part of an asset-mapping intervention in five communities in Canada, and builds on extant literature in the fields of disaster and emergency management, health promotion, and community development.

Results: Adaptive capacity is placed at the centre of the framework as a focal point, surrounded by four strategic areas for intervention (awareness/communication, asset/resource management, upstream-oriented leadership, and connectedness/engagement). Three drivers of adaptive capacity (empowerment, innovation, and collaboration) cross-cut the strategic areas and represent levers for action which can influence systems, people and institutions through expansion of asset literacy. Each component of the framework is embedded within the complexity and culture of a community.

Discussion: We present recommendations for how this framework can be used to guide the design of future resilience-oriented initiatives with particular emphasis on inclusive engagement across a range of functional capabilities.

Evolution of a Search: The Use of Dynamic Twitter Searches During Superstorm Sandy

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Background:
Twitter has emerged as a critical source of free and openly available information during emergency response operations, providing an unmatched level of on-the-ground situational awareness in real-time. Responders and survivors turn to Twitter to share information and resources within communities, conduct rumor control, and provide a “boots on the ground” understanding of the disaster. However, the ability to tune out background “noise” is essential to effectively utilizing Twitter to identify important and useful information during an emergency response.

Methods:
This article highlights a two-prong strategy in which the use of a Twitter list paired with subject specific Boolean searches provided increased situational awareness and early event detection during the United States Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR) response to Superstorm Sandy in 2012. To maximize the amount of relevant information that was retrieved, the Twitter list and Boolean searches were dynamic and responsive to real-time developments, evolving health threats, and the informational needs of decision-makers.

Conclusion:
The use of a Twitter list combined with Boolean searches led to enhanced situational awareness throughout the HHS response. The incorporation of a dynamic search strategy over the course of the HHS Sandy response, allowed for the ability to account for over-tweeted information, changes in event related conversation, and decreases in the return of relevant information.

Site Selection Criteria for Sheltering after Earthquakes: A Systematic Review

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Objective: Proper shelter site selection is necessary for long-term welfare of earthquake affected people. This study aims to explore the criteria that need to be considered after earthquakes.
Methods: Through a systematic review, 273 articles found that were published till April 2014. Among these, seven articles have been selected and analyzed for the criteria that they introduced for sheltering site selection after earthquakes.
Results: Out of 27 proposed criteria, accessibility and proximity to homes of affected people were stressed in all the papers. Moreover, seven other criteria were the same in most of the papers including suitable size, suitable distance from hazardous areas, geological hazards and land slope, suitable distance from medical centers, water supply and Security.
We categorized all the mentioned criteria in six main categories. Size and location, disaster risk reduction, relief and rescue facilities, feasibility of the site, environmental and social aspects are the main categories.
Conclusion: Selection and applying proper criteria for shelter site selection after earthquakes is a multi-disciplinary task. The decision needs relevant models and/or tools. Geographic Information System (GIS) is a useful tool for this purpose.

Key words: Disaster, earthquake, shelter, site selection, systematic review