The Great East Japan Earthquake and the subsequent tsunami that occurred in the afternoon of March 11, 2011, destroyed large parts of Japan’s Tohoku district. Owing to the unfavorable living environment, many diabetic patients in the refuges lost control of their blood glucose levels, and in addition, the high-calorie food provided led to severe postprandial hyperglycemia. We recommend that diabetic patients keep personal stocks of medical supplies and the medication that they require daily, as well as records of their medication. We also recommend the creation of basic guidelines to facilitate the practical prescription of medication for diabetic patients under various conditions that may arise in the aftermath of a natural disaster.
Background: In 2003, the Task Force on Quality Control of Disaster Management (WADEM) published guidelines for evaluation and research on health disaster management and recommended the development of a uniform data reporting tool. Standardized and complete reporting of data related to disaster medical response activities will facilitate the interpretation of results, comparisons between medical response systems and quality improvement in the management of disaster victims.
Methods: Over a two-year period, a group of 16 experts in the fields of research, education, ethics and operational aspects of disaster medical management from 8 countries carried out a consensus process based on a modified Delphi method and Utstein-style technique.
Results: The EMDM Academy Consensus Group produced an Utstein-style template for uniform data reporting of acute disaster medical response, including 15 data elements with indicators, that can be used for both research and quality improvement.
Conclusion: It is anticipated that the Utstein-style template will enable better and more accurate completion of reports on disaster medical response and contribute to further scientific evidence and knowledge related to disaster medical management in order to optimize medical response system interventions and to improve outcomes of disaster victims.
Cholera is an endemic disease in certain well-defined areas in the east of the Democratic Republic of Congo (DRC). The west of the country, including the mega-city Kinshasa, has been free of cases since mid 2001 when the last outbreak ended. Methods and Findings: We used routinely collected passive surveillance data to construct epidemic curves of the cholera cases and map the spatio-temporal progress of the disease during the first 47 weeks of 2011. We compared the spatial distribution of disease spread to that which occurred in the last cholera epidemic in Kinshasa between 1996 and 2001. To better understand previous determinants of cholera spread in this region, we conducted a correlation analysis to assess the impact of rainfall on weekly health zone cholera case counts between December 1998 and March 2001 and a Generalized Linear Model (GLM) regression analysis to identify factors that have been associated with the most vulnerable health zones within Kinshasa between October 1998 and June 1999. In February 2011, cholera reemerged in a region surrounding Kisangani and gradually spread westwards following the course of the Congo River to Kinshasa, home to 10 million people. Ten sampled isolates were confirmed to be Vibrio cholerae O1, biotype El Tor, serotype Inaba, resistant to trimethoprim-sulfa, furazolidone, nalidixic acid, sulfisoxaole, and streptomycin, and intermediate resistant to Chloramphenicol. An analysis of a previous outbreak in Kinshasa shows that rainfall was correlated with case counts and that health zone population densities as well as fishing and trade activities were predictors of case counts. Conclusion: Cholera is particularly difficult to tackle in the DRC. Given the duration of the rainy season and increased riverine traffic from the eastern provinces in late 2011, we expect further increases in cholera in the coming months and especially within the mega-city Kinshasa. We urge all partners involved in the response to remain alert.
Background: July 2006 was the first major heat wave in France after the creation of a heat prevention plan. Understanding its impacts on health will help improving the efficiency of this plan. We assessed the mortality impact of the heat wave, and investigated the influence of the heat prevention plan.
Methods: The study focused on nine French cities. A Poisson regression model was used to analyze the correlation between temperature, air quality and mortality. An additional spline of time was introduced to capture an additional heat wave effect. Heat-action days defined by the prevention plan were introduced as a dummy variable.
Results: 411 extra deaths were observed in the nine cities during the 2006 heat wave. Unlike the 2003 heat wave, no additional heat wave effect was observed in 2006. The maximum daily relative risk of mortality varied from 1.45 in Strasbourg (IC 95% [1.01-2.08]) to 1.04 in Lille (IC 95% [0.92-1.18]). The impact on mortality of the implementation of heat-action days was non-significant and highly variable depending on the cities, with a combined excess of relative risk of -3.3% (IC 95% [-10.3%; 4.4%]).
Conclusions: Although no specific heat wave effect was observed, warm temperatures and air pollution were still responsible for a significant excess mortality in France. The absence of a specific heat wave effect may be partly explained by the prevention plan. It may also indicate that higher temperatures are required to observe a mortality outburst.
Objective: To model the possible air pollution-related health impact of the 2005 oil depot fire at Buncefield, near London, UK, under alternative meteorological conditions to those experienced at the time.
Design: Atmospheric dispersion modelling of the smoke plume was conducted under the range of meteorological conditions occurring throughout 2005 assuming constant particle emission rates. Population exposure to particle concentrations (PM10) was calculated by linking the atmospheric dispersion modelling data (2 km resolution) and postcode population data. Health impacts were estimated using time-series-based exposure-response relationships for PM10 available from the epidemiological literature.
Main outcomes: Estimates of pollution-related deaths brought forward, emergency hospital admissions from respiratory problems and emergency hospital admissions from cardiovascular disease.
Findings: The highest four-day population exposure to PM10 for meteorological data from 2005 was predicted to occur between 5 and 8 August 2005, when northerly winds would have carried the plume towards London and surrounding areas of high population density. On these days, we estimated the additional PM10 exposure would have resulted in around 12 extra deaths brought forward, and around 13 additional emergency hospital admissions and a similar additional number of emergency admissions for cardiovascular disease. These numbers are slightly greater than estimated deaths and emergency admissions attributable to regular anthropogenic PM10 concentrations in south east England over the same four day period.
Conclusions: Although the particle pollution-related health impacts of the Buncefield fire could have been higher under different meteorological conditions, it is unlikely that the impacts would be substantially greater than those attributable to regular anthropogenic particle pollution over the similar period.
Keywords: oil depot fire; health impact; epidemiology; air pollution; explosion; atmospheric dispersion modelling; exposure
Introduction: Reviews of mass gathering events have traditionally concentrated on crowd variables that affect the level and type of medical care needed. Crowd disasters at mass gathering events have not been fully researched and this review examines these aiming to provide future suggestions for event organisers, medical resource planners, and emergency services, including local hospital emergency departments.
Methods: A review was conducted using computerised data bases: MEDLINE, The Cochrane Library, HMIC and EMBASE, with Google used to widen the search beyond peer-reviewed publications, to identify grey literature. All peer-review literature articles found containing information pertaining to lessons identified from mass gathering crowd disasters were analysed and reviewed. Disasters occurring in extreme weather events, and environmental leading to participant illness were not included. These articles were read, analysed, abstracted and summarised.
Results: 156 articles from literature search were found detailing mass gathering disasters identified from 1971 – 2011. With only 21 cases found within peer-review literature. Twelve events were further documented as a case reports. Five events were examined as review articles while four events underwent commissioned inquiries. Analysis of cases were categorised in to crowd control, event access, fire safety, medical preparedness and emergency response.
Conclusions: Mass gathering events have an enormous potential to place a severe strain on the local health care system, and a mixture of high crowd density, restricted points of access, poor fire safety, minimum crowd control and lack of on-site medical care can lead to problems that end in disaster.
Since mid 2011 the tragedy unfolding across the Horn of Africa following prolonged drought in the region has been a major focus for international relief operations and emergency aid. However, the most effective strategies for mitigating the effects of the drought have not been given sufficient media coverage or discussed critically enough in the public arena. Instead, while important and necessary, the focus has largely remained on emotive pleas for increased aid. This unfortunately, detracts from a considered discourse on the most effective interventions in the current circumstances and reduces scrutiny on performance of the primary agencies and bodies responsible for coordinating the relief effort. The authors present a personal perspective having recently returned from the Dadaab refugee camps where much of the relief effort has focused.
Background: Construction of houses in homesteads and their settings occur in the context of traditional perceptions and practices in the rural culture of Bangladesh. Functional spaces inside and around the house are produced according to need over time. Inhabitants construct their houses with locally available resources and knowledge. After devastating disasters houses are delivered as products by the development agencies to quickly cater to the needs of the sufferers. The extreme poor are the receivers and inhabitants of these new houses, which can cause significant changes in the physical and environmental characteristics of the neighborhood. In this regard the building and dwelling values of the inhabitants in relation with these houses may be changed or lost. But these values are otherwise inherent characters of the rural houses in the habitations that are shaped by the aspirations of the dwellers.
Methods and Findings: This paper investigates how relief houses serve the needs of the extreme poor after disasters and how these houses gradually blend with the surrounding environment matching with the aspirations of the inhabitants. The methodology followed was observation of the backgrounds of the pre and post disaster situations, focus group discussions, drawings sessions and interviews with the inhabitants, craftsmen and locals, use of secondary sources, and visits to the houses during and after construction to understand the techniques and space value.
Conclusions: The present practice of distribution of relief houses without involvement of the owners either in the information sharing or building processes and without understanding owners’ perceptions about dwellings, may compromise the compatibility and hence the sustainability of relief houses. Hence, houses may only be used as temporary or transitional shelters to sustain life in the disaster phase, and will not be used as “houses” long term.
Background: In this paper we examine the role of collective action in assisting rural communities to cope with and adapt to environmental risks in Nepalgunj, Nepal and Krabi Province, Thailand. Drawing upon two case studies, we explore the role of collective action in building adaptive capacity, paying particular attention to the role of social networks.
Methods: Data for this paper was gathered using a range of different methods across the two different studies. In Nepal semi-structured interviews were conducted with a range of stakeholders in addition to participant observation and secondary data collection. In Thailand the researchers utilised a vulnerability assessment, participatory multi-stakeholder assessment, a detailed case study and an online dialogue.
Findings: We make three key observations: firstly, collective action plays a significant role in enhancing adaptive capacity and hence should be more strongly considered in the development of climate change adaptation strategies; secondly, social networks are a particularly important component of collective action for the building of adaptive capacity; and thirdly, the mandate, capacity, and structure of local government agencies can influence the effectiveness of collective action, both positively and negatively.
Conclusions: We argue that there is an urgent need for further consideration of the different forms of collective action within community-based disaster risk management and climate change adaptation.
Systematic reviews are now regarded as a key component of the decision making process in health care, and, increasingly, in other areas. This should also be true in disaster risk reduction, planning and response. Since the Indian Ocean tsunami in 2004, The Cochrane Collaboration and others have been working together to strengthen the use and usefulness of systematic reviews in this field, through Evidence Aid. Evidence Aid is conducting a survey to identify the attitudes of those involved in the humanitarian response to natural disasters and other crises towards systematic reviews and research in such settings; their priorities for evidence, and their preferences for how the information should be made accessible. This article contains an outline of the survey instrument, which is available in full from www.EvidenceAid.org. The preliminary findings of the survey will be published in future articles.