%PDF-1.3 1 0 obj << /Type /Catalog /Outlines 2 0 R /Pages 3 0 R >> endobj 2 0 obj << /Type /Outlines /Count 0 >> endobj 3 0 obj << /Type /Pages /Kids [6 0 R 62 0 R 72 0 R 183 0 R 371 0 R 523 0 R 549 0 R 551 0 R ] /Count 8 /Resources << /ProcSet 4 0 R /Font << /F1 8 0 R /F2 9 0 R /F3 10 0 R /F4 11 0 R >> /XObject << /I1 12 0 R /I2 13 0 R /I3 64 0 R /I4 67 0 R /I5 78 0 R >> >> /MediaBox [0.000 0.000 612.000 792.000] >> endobj 4 0 obj [/PDF /Text /ImageC ] endobj 5 0 obj << /Creator (DOMPDF) /CreationDate (D:20180721152030+00'00') /ModDate (D:20180721152030+00'00') /Title (The Role of Veterans Affairs in Emergency Management: A Systematic Literature Review PLOS Currents Disasters) >> endobj 6 0 obj << /Type /Page /Parent 3 0 R /Annots [ 14 0 R 16 0 R 18 0 R 20 0 R 22 0 R 24 0 R 26 0 R 28 0 R 30 0 R 32 0 R 34 0 R 36 0 R 38 0 R 40 0 R 42 0 R 44 0 R 46 0 R 48 0 R 50 0 R 52 0 R 54 0 R 56 0 R 58 0 R 60 0 R ] /Contents 7 0 R >> endobj 7 0 obj << /Length 16586 >> stream q 375.000 0 0 39.000 222.000 738.000 cm /I2 Do Q q 15.000 684.354 577.500 53.646 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Systematic Literature Review)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 675.088 Td /F3 9.8 Tf [(December 12, 2012)] TJ ET BT 96.500 675.088 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 101.375 675.088 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 663.247 Td /F1 9.8 Tf [(Maria Claver)] TJ ET 0.271 0.267 0.267 rg BT 81.503 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 86.924 663.247 Td /F1 9.8 Tf [(Darya Friedman)] TJ ET 0.271 0.267 0.267 rg BT 156.812 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 162.233 663.247 Td /F1 9.8 Tf [(Aram Dobalian)] TJ ET 0.271 0.267 0.267 rg BT 226.710 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 232.131 663.247 Td /F1 9.8 Tf [(Karen Ricci)] TJ ET 0.271 0.267 0.267 rg BT 281.973 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 287.394 663.247 Td /F1 9.8 Tf [(Melanie Horn Mallers)] TJ ET 0.271 0.267 0.267 rg BT 26.250 651.342 Td /F1 9.8 Tf [(Claver M, Friedman D, Dobalian A, Ricci K, Horn Mallers M. The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 26.250 639.438 Td /F1 9.8 Tf [(Systematic Literature Review. PLOS Currents Disasters. 2012 Dec 12 . Edition 1. doi: )] TJ ET BT 26.250 627.533 Td /F1 9.8 Tf [(10.1371/198d344bc40a75f927c9bc5024279815.)] TJ ET q 15.000 -235.920 577.500 861.072 re W n 0.271 0.267 0.267 rg BT 26.250 598.430 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 578.476 Td /F1 9.8 Tf [(The Department of Veterans Affairs \(VA\) is a key player in emergency management for both veterans and civilians. )] TJ ET BT 26.250 566.571 Td /F1 9.8 Tf [(Unfortunately, limited evidence-based research findings exist regarding the role and experience of VA during disasters. The )] TJ ET BT 26.250 554.667 Td /F1 9.8 Tf [(present study is a systematic literature review of 41 published, peer-reviewed articles regarding VA and emergency )] TJ ET BT 26.250 542.762 Td /F1 9.8 Tf [(management. Trained researchers utilized a data abstraction tool and conducted a qualitative content analysis. A description of )] TJ ET BT 26.250 530.857 Td /F1 9.8 Tf [(article characteristics include methodology, phase of emergency management addressed in the research, and study design. )] TJ ET BT 26.250 518.952 Td /F1 9.8 Tf [(Five topic categories emerged from the review including effects of disaster on mental health status and services use, effects of )] TJ ET BT 26.250 507.048 Td /F1 9.8 Tf [(disaster on general health services use, patient tracking, evacuation, and disaster planning/preparation. Findings were used to )] TJ ET BT 26.250 495.143 Td /F1 9.8 Tf [(generate suggestions for future research.)] TJ ET BT 26.250 475.738 Td /F1 9.8 Tf [(Keywords: Veterans Affairs, veterans, disaster, emergency)] TJ ET BT 26.250 439.136 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 419.181 Td /F1 9.8 Tf [(This material is based upon work supported \(or supported in part\) by the Department of Veterans Affairs, Veterans Health )] TJ ET BT 26.250 407.277 Td /F1 9.8 Tf [(Administration, Office of Public Health and Environmental Hazards \(Grant no. XVA 65-020\). The views expressed in this article )] TJ ET BT 26.250 395.372 Td /F1 9.8 Tf [(are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United )] TJ ET BT 26.250 383.467 Td /F1 9.8 Tf [(States government.)] TJ ET BT 26.250 354.365 Td /F4 12.0 Tf [(BACKGROUND)] TJ ET BT 26.250 334.410 Td /F1 9.8 Tf [(In addition to its primary mission to provide health services for veterans, the Department of Veterans Affairs \(VA\) is responsible )] TJ ET BT 26.250 322.506 Td /F1 9.8 Tf [(for assisting federal agencies and the general public during emergencies as directed by the 1982 VA/Department of Defense )] TJ ET BT 26.250 310.601 Td /F1 9.8 Tf [(Health Resources Sharing and Emergency Operation Act \(Pub. L. 97-174\). Given its nationwide presence, VA must respond to )] TJ ET BT 26.250 298.696 Td /F1 9.8 Tf [(the range of emergencies and disasters through participation in the mitigation, preparedness, response, and recovery stages of )] TJ ET BT 26.250 286.791 Td /F1 9.8 Tf [(emergency management. It does so, in part, through collaboration with other governmental, non-profit, and for profit agencies.)] TJ ET BT 26.250 267.387 Td /F1 9.8 Tf [(Collaboration requires effective communication through information dissemination. Existing research outside of VA does not )] TJ ET BT 26.250 255.482 Td /F1 9.8 Tf [(adequately address the needs of those in disasters or VAs activities in assisting its partners. Information about VA and )] TJ ET BT 26.250 243.577 Td /F1 9.8 Tf [(emergency management is most often found in VA internal after action reports and is not widely disseminated. There is an )] TJ ET BT 26.250 231.672 Td /F1 9.8 Tf [(urgent need for evidence-based research related to disaster and emergency response processes that VA is likely to engage in. )] TJ ET BT 26.250 219.768 Td /F1 9.8 Tf [(This review thus aimed to explore and summarize the current scientific literature about VA and emergency management and )] TJ ET BT 26.250 207.863 Td /F1 9.8 Tf [(make suggestions for future research.)] TJ ET BT 26.250 171.260 Td /F4 12.0 Tf [(METHOD)] TJ ET Q q 15.000 684.354 577.500 53.646 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Systematic Literature Review)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 675.088 Td /F3 9.8 Tf [(December 12, 2012)] TJ ET BT 96.500 675.088 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 101.375 675.088 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 663.247 Td /F1 9.8 Tf [(Maria Claver)] TJ ET 0.271 0.267 0.267 rg BT 81.503 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 86.924 663.247 Td /F1 9.8 Tf [(Darya Friedman)] TJ ET 0.271 0.267 0.267 rg BT 156.812 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 162.233 663.247 Td /F1 9.8 Tf [(Aram Dobalian)] TJ ET 0.271 0.267 0.267 rg BT 226.710 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 232.131 663.247 Td /F1 9.8 Tf [(Karen Ricci)] TJ ET 0.271 0.267 0.267 rg BT 281.973 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 287.394 663.247 Td /F1 9.8 Tf [(Melanie Horn Mallers)] TJ ET 0.271 0.267 0.267 rg BT 26.250 651.342 Td /F1 9.8 Tf [(Claver M, Friedman D, Dobalian A, Ricci K, Horn Mallers M. The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 26.250 639.438 Td /F1 9.8 Tf [(Systematic Literature Review. PLOS Currents Disasters. 2012 Dec 12 . Edition 1. doi: )] TJ ET BT 26.250 627.533 Td /F1 9.8 Tf [(10.1371/198d344bc40a75f927c9bc5024279815.)] TJ ET q 15.000 -235.920 577.500 861.072 re W n 0.271 0.267 0.267 rg BT 26.250 598.430 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 578.476 Td /F1 9.8 Tf [(The Department of Veterans Affairs \(VA\) is a key player in emergency management for both veterans and civilians. )] TJ ET BT 26.250 566.571 Td /F1 9.8 Tf [(Unfortunately, limited evidence-based research findings exist regarding the role and experience of VA during disasters. The )] TJ ET BT 26.250 554.667 Td /F1 9.8 Tf [(present study is a systematic literature review of 41 published, peer-reviewed articles regarding VA and emergency )] TJ ET BT 26.250 542.762 Td /F1 9.8 Tf [(management. Trained researchers utilized a data abstraction tool and conducted a qualitative content analysis. A description of )] TJ ET BT 26.250 530.857 Td /F1 9.8 Tf [(article characteristics include methodology, phase of emergency management addressed in the research, and study design. )] TJ ET BT 26.250 518.952 Td /F1 9.8 Tf [(Five topic categories emerged from the review including effects of disaster on mental health status and services use, effects of )] TJ ET BT 26.250 507.048 Td /F1 9.8 Tf [(disaster on general health services use, patient tracking, evacuation, and disaster planning/preparation. Findings were used to )] TJ ET BT 26.250 495.143 Td /F1 9.8 Tf [(generate suggestions for future research.)] TJ ET BT 26.250 475.738 Td /F1 9.8 Tf [(Keywords: Veterans Affairs, veterans, disaster, emergency)] TJ ET BT 26.250 439.136 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 419.181 Td /F1 9.8 Tf [(This material is based upon work supported \(or supported in part\) by the Department of Veterans Affairs, Veterans Health )] TJ ET BT 26.250 407.277 Td /F1 9.8 Tf [(Administration, Office of Public Health and Environmental Hazards \(Grant no. XVA 65-020\). The views expressed in this article )] TJ ET BT 26.250 395.372 Td /F1 9.8 Tf [(are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United )] TJ ET BT 26.250 383.467 Td /F1 9.8 Tf [(States government.)] TJ ET BT 26.250 354.365 Td /F4 12.0 Tf [(BACKGROUND)] TJ ET BT 26.250 334.410 Td /F1 9.8 Tf [(In addition to its primary mission to provide health services for veterans, the Department of Veterans Affairs \(VA\) is responsible )] TJ ET BT 26.250 322.506 Td /F1 9.8 Tf [(for assisting federal agencies and the general public during emergencies as directed by the 1982 VA/Department of Defense )] TJ ET BT 26.250 310.601 Td /F1 9.8 Tf [(Health Resources Sharing and Emergency Operation Act \(Pub. L. 97-174\). Given its nationwide presence, VA must respond to )] TJ ET BT 26.250 298.696 Td /F1 9.8 Tf [(the range of emergencies and disasters through participation in the mitigation, preparedness, response, and recovery stages of )] TJ ET BT 26.250 286.791 Td /F1 9.8 Tf [(emergency management. It does so, in part, through collaboration with other governmental, non-profit, and for profit agencies.)] TJ ET BT 26.250 267.387 Td /F1 9.8 Tf [(Collaboration requires effective communication through information dissemination. Existing research outside of VA does not )] TJ ET BT 26.250 255.482 Td /F1 9.8 Tf [(adequately address the needs of those in disasters or VAs activities in assisting its partners. Information about VA and )] TJ ET BT 26.250 243.577 Td /F1 9.8 Tf [(emergency management is most often found in VA internal after action reports and is not widely disseminated. There is an )] TJ ET BT 26.250 231.672 Td /F1 9.8 Tf [(urgent need for evidence-based research related to disaster and emergency response processes that VA is likely to engage in. )] TJ ET BT 26.250 219.768 Td /F1 9.8 Tf [(This review thus aimed to explore and summarize the current scientific literature about VA and emergency management and )] TJ ET BT 26.250 207.863 Td /F1 9.8 Tf [(make suggestions for future research.)] TJ ET BT 26.250 171.260 Td /F4 12.0 Tf [(METHOD)] TJ ET Q q 15.000 684.354 577.500 53.646 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Systematic Literature Review)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 675.088 Td /F3 9.8 Tf [(December 12, 2012)] TJ ET BT 96.500 675.088 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 101.375 675.088 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 663.247 Td /F1 9.8 Tf [(Maria Claver)] TJ ET 0.271 0.267 0.267 rg BT 81.503 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 86.924 663.247 Td /F1 9.8 Tf [(Darya Friedman)] TJ ET 0.271 0.267 0.267 rg BT 156.812 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 162.233 663.247 Td /F1 9.8 Tf [(Aram Dobalian)] TJ ET 0.271 0.267 0.267 rg BT 226.710 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 232.131 663.247 Td /F1 9.8 Tf [(Karen Ricci)] TJ ET 0.271 0.267 0.267 rg BT 281.973 663.247 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 287.394 663.247 Td /F1 9.8 Tf [(Melanie Horn Mallers)] TJ ET 0.271 0.267 0.267 rg BT 26.250 651.342 Td /F1 9.8 Tf [(Claver M, Friedman D, Dobalian A, Ricci K, Horn Mallers M. The Role of Veterans Affairs in Emergency Management: A )] TJ ET BT 26.250 639.438 Td /F1 9.8 Tf [(Systematic Literature Review. PLOS Currents Disasters. 2012 Dec 12 . Edition 1. doi: )] TJ ET BT 26.250 627.533 Td /F1 9.8 Tf [(10.1371/198d344bc40a75f927c9bc5024279815.)] TJ ET q 15.000 -235.920 577.500 861.072 re W n 0.271 0.267 0.267 rg BT 26.250 598.430 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 578.476 Td /F1 9.8 Tf [(The Department of Veterans Affairs \(VA\) is a key player in emergency management for both veterans and civilians. )] TJ ET BT 26.250 566.571 Td /F1 9.8 Tf [(Unfortunately, limited evidence-based research findings exist regarding the role and experience of VA during disasters. The )] TJ ET BT 26.250 554.667 Td /F1 9.8 Tf [(present study is a systematic literature review of 41 published, peer-reviewed articles regarding VA and emergency )] TJ ET BT 26.250 542.762 Td /F1 9.8 Tf [(management. Trained researchers utilized a data abstraction tool and conducted a qualitative content analysis. A description of )] TJ ET BT 26.250 530.857 Td /F1 9.8 Tf [(article characteristics include methodology, phase of emergency management addressed in the research, and study design. )] TJ ET BT 26.250 518.952 Td /F1 9.8 Tf [(Five topic categories emerged from the review including effects of disaster on mental health status and services use, effects of )] TJ ET BT 26.250 507.048 Td /F1 9.8 Tf [(disaster on general health services use, patient tracking, evacuation, and disaster planning/preparation. Findings were used to )] TJ ET BT 26.250 495.143 Td /F1 9.8 Tf [(generate suggestions for future research.)] TJ ET BT 26.250 475.738 Td /F1 9.8 Tf [(Keywords: Veterans Affairs, veterans, disaster, emergency)] TJ ET BT 26.250 439.136 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 419.181 Td /F1 9.8 Tf [(This material is based upon work supported \(or supported in part\) by the Department of Veterans Affairs, Veterans Health )] TJ ET BT 26.250 407.277 Td /F1 9.8 Tf [(Administration, Office of Public Health and Environmental Hazards \(Grant no. XVA 65-020\). The views expressed in this article )] TJ ET BT 26.250 395.372 Td /F1 9.8 Tf [(are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United )] TJ ET BT 26.250 383.467 Td /F1 9.8 Tf [(States government.)] TJ ET BT 26.250 354.365 Td /F4 12.0 Tf [(BACKGROUND)] TJ ET BT 26.250 334.410 Td /F1 9.8 Tf [(In addition to its primary mission to provide health services for veterans, the Department of Veterans Affairs \(VA\) is responsible )] TJ ET BT 26.250 322.506 Td /F1 9.8 Tf [(for assisting federal agencies and the general public during emergencies as directed by the 1982 VA/Department of Defense )] TJ ET BT 26.250 310.601 Td /F1 9.8 Tf [(Health Resources Sharing and Emergency Operation Act \(Pub. L. 97-174\). Given its nationwide presence, VA must respond to )] TJ ET BT 26.250 298.696 Td /F1 9.8 Tf [(the range of emergencies and disasters through participation in the mitigation, preparedness, response, and recovery stages of )] TJ ET BT 26.250 286.791 Td /F1 9.8 Tf [(emergency management. It does so, in part, through collaboration with other governmental, non-profit, and for profit agencies.)] TJ ET BT 26.250 267.387 Td /F1 9.8 Tf [(Collaboration requires effective communication through information dissemination. Existing research outside of VA does not )] TJ ET BT 26.250 255.482 Td /F1 9.8 Tf [(adequately address the needs of those in disasters or VAs activities in assisting its partners. Information about VA and )] TJ ET BT 26.250 243.577 Td /F1 9.8 Tf [(emergency management is most often found in VA internal after action reports and is not widely disseminated. 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232.1310 662.3453 281.9730 672.2659 ] >> endobj 59 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/disasters/author/karen-ricciva-gov/) >> endobj 60 0 obj << /Type /Annot /Subtype /Link /A 61 0 R /Border [0 0 0] /H /I /Rect [ 287.3940 662.3453 379.4925 672.2659 ] >> endobj 61 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/disasters/author/mhornmallersfullerton-edu/) >> endobj 62 0 obj << /Type /Page /Parent 3 0 R /Annots [ 65 0 R 68 0 R 70 0 R ] /Contents 63 0 R >> endobj 63 0 obj << /Length 8187 >> stream 0.271 0.267 0.267 rg q 15.000 30.679 577.500 746.321 re W n q 450.000 0 0 396.750 26.250 380.250 cm /I3 Do Q 0.271 0.267 0.267 rg BT 26.250 363.226 Td /F1 9.8 Tf [(The first step included searching for relevant emergency management peer-reviewed articles published between 1982 and )] TJ ET BT 26.250 351.321 Td /F1 9.8 Tf [(2012. RAND Corporation librarians used disaster-related search terms using relevant academic databases \(see Table 1\) to )] TJ ET BT 26.250 339.417 Td /F1 9.8 Tf [(provide the research team with a list of articles \(n=877\) that met initial search criteria \(i.e. contained search terms mentioned )] TJ ET BT 26.250 327.512 Td /F1 9.8 Tf [(above in the title, keywords, or abstract\). Of the 877 articles, 798 were rejected at title review as clearly irrelevant to the project )] TJ ET BT 26.250 315.607 Td /F1 9.8 Tf [(or were excluded as they were not published in peer-reviewed journals. This left 79 peer-reviewed articles that were then )] TJ ET BT 26.250 303.702 Td /F1 9.8 Tf [(reviewed using the following inclusion criteria: 1\) the article discussed emergency management, and 2\) the article discussed )] TJ ET BT 26.250 291.798 Td /F1 9.8 Tf [(services directly provided by VA, services for which VA contracted from outside entities, or veterans served by VA. Thirty-nine )] TJ ET BT 26.250 279.893 Td /F1 9.8 Tf [(articles met the criteria. The reference lists for these articles were then reviewed for possible inclusion; all but 5 articles were )] TJ ET BT 26.250 267.988 Td /F1 9.8 Tf [(rejected at title review. Of the 5, only 2 met the full inclusion criteria. Thus, 41 total articles were included in the final review for )] TJ ET BT 26.250 256.083 Td /F1 9.8 Tf [(meeting criteria \(Figure 1\).)] TJ ET 0.965 0.965 0.965 rg 26.250 85.798 555.000 160.405 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 246.203 m 581.250 246.203 l 581.250 245.453 l 26.250 245.453 l f 26.250 85.798 m 581.250 85.798 l 581.250 86.548 l 26.250 86.548 l f q 225.000 0 0 115.500 35.250 120.953 cm /I4 Do Q q 35.250 97.048 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 105.429 Td /F4 9.8 Tf [(Fig. 1: Literature Search Flow)] TJ ET Q BT 26.250 68.774 Td /F1 9.8 Tf [(All of the articles were then fully reviewed using a data abstraction instrument designed for this study and reviewed by the )] TJ ET BT 26.250 56.869 Td /F1 9.8 Tf [(VA/UCLA/RAND Southern California Evidence-Based Practice Center \(Figure 2\). The data abstraction instrument categories )] TJ ET BT 26.250 44.964 Td /F1 9.8 Tf [(were compiled from literature reviews, pilot testing of the instrument, and input from experts in emergency management )] TJ ET Q q 15.000 30.679 577.500 746.321 re W n q 450.000 0 0 396.750 26.250 380.250 cm /I3 Do Q 0.271 0.267 0.267 rg BT 26.250 363.226 Td /F1 9.8 Tf [(The first step included searching for relevant emergency management peer-reviewed articles published between 1982 and )] TJ ET BT 26.250 351.321 Td /F1 9.8 Tf [(2012. RAND Corporation librarians used disaster-related search terms using relevant academic databases \(see Table 1\) to )] TJ ET BT 26.250 339.417 Td /F1 9.8 Tf [(provide the research team with a list of articles \(n=877\) that met initial search criteria \(i.e. contained search terms mentioned )] TJ ET BT 26.250 327.512 Td /F1 9.8 Tf [(above in the title, keywords, or abstract\). Of the 877 articles, 798 were rejected at title review as clearly irrelevant to the project )] TJ ET BT 26.250 315.607 Td /F1 9.8 Tf [(or were excluded as they were not published in peer-reviewed journals. This left 79 peer-reviewed articles that were then )] TJ ET BT 26.250 303.702 Td /F1 9.8 Tf [(reviewed using the following inclusion criteria: 1\) the article discussed emergency management, and 2\) the article discussed )] TJ ET BT 26.250 291.798 Td /F1 9.8 Tf [(services directly provided by VA, services for which VA contracted from outside entities, or veterans served by VA. Thirty-nine )] TJ ET BT 26.250 279.893 Td /F1 9.8 Tf [(articles met the criteria. The reference lists for these articles were then reviewed for possible inclusion; all but 5 articles were )] TJ ET BT 26.250 267.988 Td /F1 9.8 Tf [(rejected at title review. Of the 5, only 2 met the full inclusion criteria. Thus, 41 total articles were included in the final review for )] TJ ET BT 26.250 256.083 Td /F1 9.8 Tf [(meeting criteria \(Figure 1\).)] TJ ET 0.965 0.965 0.965 rg 26.250 85.798 555.000 160.405 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 246.203 m 581.250 246.203 l 581.250 245.453 l 26.250 245.453 l f 26.250 85.798 m 581.250 85.798 l 581.250 86.548 l 26.250 86.548 l f q 225.000 0 0 115.500 35.250 120.953 cm /I4 Do Q q 35.250 97.048 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 105.429 Td /F4 9.8 Tf [(Fig. 1: Literature Search Flow)] TJ ET Q BT 26.250 68.774 Td /F1 9.8 Tf [(All of the articles were then fully reviewed using a data abstraction instrument designed for this study and reviewed by the )] TJ ET BT 26.250 56.869 Td /F1 9.8 Tf [(VA/UCLA/RAND Southern California Evidence-Based Practice Center \(Figure 2\). The data abstraction instrument categories )] TJ ET BT 26.250 44.964 Td /F1 9.8 Tf [(were compiled from literature reviews, pilot testing of the instrument, and input from experts in emergency management )] TJ ET Q q 15.000 30.679 577.500 746.321 re W n q 450.000 0 0 396.750 26.250 380.250 cm /I3 Do Q 0.271 0.267 0.267 rg BT 26.250 363.226 Td /F1 9.8 Tf [(The first step included searching for relevant emergency management peer-reviewed articles published between 1982 and )] TJ ET BT 26.250 351.321 Td /F1 9.8 Tf [(2012. RAND Corporation librarians used disaster-related search terms using relevant academic databases \(see Table 1\) to )] TJ ET BT 26.250 339.417 Td /F1 9.8 Tf [(provide the research team with a list of articles \(n=877\) that met initial search criteria \(i.e. contained search terms mentioned )] TJ ET BT 26.250 327.512 Td /F1 9.8 Tf [(above in the title, keywords, or abstract\). Of the 877 articles, 798 were rejected at title review as clearly irrelevant to the project )] TJ ET BT 26.250 315.607 Td /F1 9.8 Tf [(or were excluded as they were not published in peer-reviewed journals. This left 79 peer-reviewed articles that were then )] TJ ET BT 26.250 303.702 Td /F1 9.8 Tf [(reviewed using the following inclusion criteria: 1\) the article discussed emergency management, and 2\) the article discussed )] TJ ET BT 26.250 291.798 Td /F1 9.8 Tf [(services directly provided by VA, services for which VA contracted from outside entities, or veterans served by VA. Thirty-nine )] TJ ET BT 26.250 279.893 Td /F1 9.8 Tf [(articles met the criteria. The reference lists for these articles were then reviewed for possible inclusion; all but 5 articles were )] TJ ET BT 26.250 267.988 Td /F1 9.8 Tf [(rejected at title review. Of the 5, only 2 met the full inclusion criteria. Thus, 41 total articles were included in the final review for )] TJ ET BT 26.250 256.083 Td /F1 9.8 Tf [(meeting criteria \(Figure 1\).)] TJ ET 0.965 0.965 0.965 rg 26.250 85.798 555.000 160.405 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 246.203 m 581.250 246.203 l 581.250 245.453 l 26.250 245.453 l f 26.250 85.798 m 581.250 85.798 l 581.250 86.548 l 26.250 86.548 l f q 225.000 0 0 115.500 35.250 120.953 cm /I4 Do Q q 35.250 97.048 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 105.429 Td /F4 9.8 Tf [(Fig. 1: Literature Search Flow)] TJ ET Q BT 26.250 68.774 Td /F1 9.8 Tf [(All of the articles were then fully reviewed using a data abstraction instrument designed for this study and reviewed by the )] TJ ET BT 26.250 56.869 Td /F1 9.8 Tf [(VA/UCLA/RAND Southern California Evidence-Based Practice Center \(Figure 2\). The data abstraction instrument categories )] TJ ET BT 26.250 44.964 Td /F1 9.8 Tf [(were compiled from literature reviews, pilot testing of the instrument, and input from experts in emergency management )] TJ ET Q q 225.000 0 0 115.500 35.250 120.953 cm /I4 Do Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(2)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 64 0 obj << /Type /XObject /Subtype /Image /Width 600 /Height 529 /ColorSpace /DeviceRGB /Filter /DCTDecode /BitsPerComponent 8 /Length 100753>> stream JFIF,,C  !"$"$CX"V  !1"2AQ#7au6BUVqt$3RSTb%Crs&4v58c ?^T:Y;q biA@}gﻛ[vcvӓ2T %,"w,3݁ 5Y[|GGgTub<ǂư7 06%FԩiQGX}AI]Jŏ3 D ٩yV V>>l:4ϙ\8MsК(/FSʲ|A ޭ$?KY3F%n( ^xwFLWfiX1j³G*}A_f~*RI󏽏hǥXB{as(XI鹷lN;ڻҦۼҤs >Y@=G$wr _`Jx"5np[Ǝ"#O4dŕYSJZ0$.cr8Ӎ͖؝ǐL6>]@T*d!諤B>ҨμH';|4k7#-gHTe;5{.,DRc@Q 0~ H1HIoo͐ܮເMKf5uSBjy iIjGTxI \uO?wuC?8)ff+e+7{{I6كqY&tÔJU, CdpA㻐gܽFܛv,V*^܆g'N32"Gr^3[9ۙjR$ S#(gW-r^[5$uу+U}]-˘CvON9`?l+^9U(Gia>V9}p2e aBbD*bXp@ѬkuW/e_m3`OZǧB3v1ӈ~kaR8+!Z)dc'0s wFY܉Xqk?uʴ9-HK1d `>ëDW'[YX6vjP#8$4M4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4h 4hWdRPn O Q_ LǧOTNw-vnhlgG ı +p@Gfkp8q$||SO\(c _\s=/es))rId4eADGwwtAEy,=W9͐7 fQD<%UXx,Ix Noh|!~x8EZ~8A'xd,|FpÎ4ǣAbnirB:DLI nCǐǒO4h3&~YN ٞ2c ( `uMx$|MΤjK@Hr>NAR2lۙ-f1v+jw* e<8DM(Ԛs>leȑm\/qUp Km'I9av-ט(+n*oJ"4eA?(yq/J,9 ˒jW(ƈޅ,r: RU0дh3ݽ|#p-n طQ2yXǫ 49ynn>ͧ/2iad3%2{#_ y'f$F}[Z nCWp֮ DrXIX2I >D8SV9.+?>z&d4HEǧ<<xѠ̤C-Jnj;s R2ޙvnXsvn|M̴֞^ls#3%”e1ʌ>dyQ} cq{)2x&* $ONQspڛ<-UazM#$9S̲ ?g4h&;tgw 9ڕ݊ȋe]TTR ?<>T{)wὄuf0sD1HU=Nxh{'/ÕM& j)HK?l`ԌK"Zb9G%%xdn%~hSM e]8ߝ;v/WS R3#v x绁Ċ3U?oC N6i9hLSWBΞth3QNr[=3lѲ+1' J 塖m݃VgV)P( oo˧}FFFFFFFFFFFFFFFFFFFFFFFz3d[tqvlν"f^G9ƠMpK8K3>2rOݠmѬBKEjc؝G4ً}?W_@PhiS @Phi&\˶Sl-T Y*5HI<<R5ҧ;/T>5ҧ;/T>5ҧ;/T>5ҧ;/T>5ҧ;/T>5ҧ;/Toxv};4<TO441)9wG%NʸxR3ܱ] b䕂5619>J@Phw?%@ףJ@PkMm$ظ{t 4[zj+HA|k-g>[+vF֩V;qOfF9b*ԺɈ<0vvIW@PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS @PhiS ToZsyᤛj4|T=h4-FW?]MZV>UTo:4mSuAAyccH0E$P26"5a~}3>}jkԩ%m4XojBoi 8OzC.ÝӘuv'T7ܽ݁`7Y7xIi衇j3=[19d[3wFco=H w5m:km`!xms*ar43nC#.5ѐ>Bi^q3b3 ~1G“x*ϓ~ǵc+X$6l,5$ ȽaϓqƭKf# z8g;h+%qobOk10-e;ۉR<ÆƗE :x '<1{wR[XQ: 1| `ʁiU0l/.eo.{/A={{$XnH]m+~`$Tܽvm/"5?8uENN+c!í].)_ge,fV;=SPwSحkd1;k?_4Oc^ s#&c[\V xpNlk%vU1Ll+v{B|*,Wqʶ3zTd#|Z:Jq!b8O5.Gf 7I}=n;O7u/wuczm\yձS5N9i~1O o?,eu=-tuV82$<ܗo-mn,a7]l~T'3`2zݧ*wyWJ4l?{я'aX.=v4X?7mvNglJ5fDIon`}{}̕,jy#}"㵈ܑ~ i=}GnI{>7#+;yO܏O/4/aXpJm-ctK3&F̴l$|z̬}H:i7T:urdKsq\wY:q123gwf6͉a8,U-țBjtiɑ\+zӧ~i'z ˊI"v1J<{;xAGޥuWsif=S'c#;\E9dn3s =y#G6z}.`we},3@7)c" E%axmLG\ܭs14Sω]pOw'VZJ-,aS黯/r!Oq]zi\#q7Yj{4Ì=G?gc٧ؽTnuW P~WTOxʸ~7rקRkd5UG>:ҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|f)& h!mM6hҟ onKƏ|fz+ݿB/ާon܂INEr ?9 A X$>$ca*)#r9ҿX$>v"yT9 s$h0Z=^uny8W ЭRXd!Y!c+w8 8Ž6ԔRd!d-/E_BHX1s;ݑ @)%X#>p$j=);~[ E5VEm)nQYJJx/v_Rg7ݹ1x!T Df,@' ~l\NB܊֚@`/($Alyl6Ser.M2<&`o;;y+q:w~g :Tpn:4TI ]]b{{lf^^0CϨʂCTx'uԻW'erYqA ԻVj¯Ϧ9U\B1)'YP67:G.{LmNǞ91eV,Oߛ[m} B6]fL[]b7gwUwNw=Al8%fIZA"HU?0;HMS2 On!b&6hf aV2ۏ}oCF%tmec&qY4i,ZV&fuLd}$BsM,CGkW`AXO鴌B)=u~e?g&}|^XIrlK7B\ו${MX Ll.2ػZ^(.^:f.AZ6(ZDjl;#ѳ#ySV c~dKC W_O:["E9\9TWb 7%Ou׏ޛk!i[pL"Ivy#] [K]2xn$>msm8fHYR~UJM:N]pT2/-z|Օ"&L#Tfm-{[7Se#$wȓaQ?(%__vN?);f<>=7+]yj̵T1H+?_hYВhv>o떺{˾oBx6 V)JszD$`$#<~@`رkd]2k911N絊SI}I l 33xNOrvØ80:ݍ7P6+q3ɆOODķx=WeBU[vL} ;܊vZZJD !e#ϏmL+y*rcLbq[:;#aI ʓfMhͷ8=%^2;^ @}DJAOƜ~13pA%O Ñ濾Fm/anJxoy'#qmͱn\ٲ -8jLCCwr;,pmGZJ&6AdRB O;O'k!c dh KO:/勇IVE1TvFn{}$9WRpQݟ:-1:#Ux<mApZn E5\n+;!Cb$HUy>qW'j\C/Yk5fĐ':4Dܤ4X^΂lƎI$jIf1qe0Ƞ|m-ٟvwo϶­rX~== 4qWh;6qRAk܆e/pGBIbA/2=C4Ӕ`ت R5Xj$H+# V?+.M楐n֖I\*$b˷ ;'nՋɒV\_Y?ڣ +珙9 _C_ y5WT$&xc{3f c3:ӾY<*~rI <@z[j[ǒ+Ӳ*XzCb9ol&A/ڝܼ7:[b,ub~,8P; Oj{?|3L7jؑ+ckIc4. ܃#4lRn\u8kOMbX +#(?#B^l":_\|JSWA@bF.H!1YKgo\]g-y2]W/-S!b0q|ڟnSJێمDry,G>H#?rnhր(|^9=OO9 ssaea]l}yws ߆콿 QI ^Kإz(^D-cu]:X]Ew$(+=,XK-[5-q(Lr ܤB n{c}Up_/gNxc/B#!YH^9;>=oٞ Zl2eA,e=aBw"]LХByr13T^(vf<)=ʨPG,OT70[L\X '!9{0n \^HP=t6&Sl4k#KХIX})ˀ~<ܘ6ЙZdl_"den"^Yʏru'e&|ĩZ[pKO!4H<}jױ[S%6 t$uioL0bGq:O6⥷ec)s Q4*݊ ޤ.s5rr8̥,|GGڂ69UO[ (b>]rMSd&4@{ϨĞ@^ϖ˺ǂq]Qޠg6eQSӅPį̤Gѭ7/v۳H ;Q{O\7bry6t_-{<T,%x)cڼch $G#,e#JObYMGQ;$cګ>)],$bk_2oCY_"C {[-X|>֛vkdNZECًW6wm\KBq m^n;+q9ίSd+TK[`bj;YݱG?OxҎgmϴZhܸ,GyNѡrd*7[v]୊l+#_-~}%w ~v(H<_u r;b53s\рC#Ysy<JN\}Js->Kv7V r r(Am\.cXF3S3F|sʒAj6qrd$zun 3I=A[ x.]76asQ K^," n;X;:\2֖ަMف,2Q¯QE!>sih< =r0_LLGnyM9ݤ7,Ov jZDf3$qF[A`9 -)n|-+qr)38̹h[&Y+fn¨Uo%x'U0llAwknpkdzȯ0IՔHPp@i7cÏuW gZ%iZyL! 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The categories on the data abstraction instrument reviewed in the current study included: 1. Study )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(design \(e.g., experimental including randomized groups and a control group, quasi-experimental including comparing different )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(groups under different conditions such as time periods or regions, or pre-experimental including examination of one group over )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(time, retrospective reporting, data tracking, program evaluation or descriptive case studies\); 2. Methodology \(i.e., qualitative, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(quantitative, mixed\); and 3. Role of VA in emergency management \(i.e. mitigation/prevention, preparedness, response, )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(recovery\). Two members of the research team independently reviewed the articles and compared data coded on the data )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(abstraction instrument. In cases where coding diverged, the team obtained reliability by reaching consensus about the code or )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(via input from a third team member. Finally, the articles were reviewed using content analysis techniques )] TJ ET 0.267 0.267 0.267 rg BT 480.337 685.650 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 485.155 684.143 Td /F1 9.8 Tf [( . The primary topic )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(of each article was characterized with a code word or phrase. Articles pertaining to similar topics were then grouped together )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(into categories described below.)] TJ ET 0.965 0.965 0.965 rg 26.250 432.298 555.000 218.155 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 650.453 m 581.250 650.453 l 581.250 649.703 l 26.250 649.703 l f 26.250 432.298 m 581.250 432.298 l 581.250 433.048 l 26.250 433.048 l f q 225.000 0 0 173.250 35.250 467.453 cm /I5 Do Q q 35.250 443.548 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 451.929 Td /F4 9.8 Tf [(Fig. 2: Data Abstraction Tool)] TJ ET Q BT 26.250 398.076 Td /F4 12.0 Tf [(RESULTS)] TJ ET BT 26.250 378.122 Td /F1 9.8 Tf [(The study design of the final group of articles was experimental \(n=0\), quasi-experimental \(n=12\) or pre-experimental \(n=29\). )] TJ ET BT 26.250 366.217 Td /F1 9.8 Tf [(Methodologies included qualitative \(n=21\), quantitative \(n=19\), and mixed \(n=1\). The role of VA in the emergency management )] TJ ET BT 26.250 354.312 Td /F1 9.8 Tf [(phases included mitigation/prevention \(n=5\), preparedness \(n=2\), response \(n=8\), or recovery \(n=14\). Several articles \(n= 12\) )] TJ ET BT 26.250 342.408 Td /F1 9.8 Tf [(addressed more than one emergency management role, including two articles that addressed all four roles.)] TJ ET BT 26.250 323.003 Td /F1 9.8 Tf [(Five topic categories emerged from the review: Effects of disaster on mental health status and services use, effects of disaster )] TJ ET BT 26.250 311.098 Td /F1 9.8 Tf [(on general health services use, patient tracking, evacuation, and disaster planning/preparation.)] TJ ET BT 26.250 291.693 Td /F4 9.8 Tf [(Effects of Disaster on Mental Health)] TJ ET BT 26.250 272.289 Td /F1 9.8 Tf [(Thirteen articles relate to the effects of disaster on mental health, including service use and status. Among studies that explored )] TJ ET BT 26.250 260.384 Td /F1 9.8 Tf [(mental healthcare use for PTSD symptoms )] TJ ET 0.267 0.267 0.267 rg BT 214.815 261.891 Td /F4 8.7 Tf [(2)] TJ ET BT 219.634 261.891 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 224.452 260.384 Td /F1 9.8 Tf [( one study )] TJ ET 0.267 0.267 0.267 rg BT 272.149 261.891 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 276.968 260.384 Td /F1 9.8 Tf [( found that the use of non-VA healthcare was likely to increase )] TJ ET BT 26.250 248.479 Td /F1 9.8 Tf [(following 9/11, while another )] TJ ET 0.267 0.267 0.267 rg BT 151.976 249.986 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 156.795 248.479 Td /F1 9.8 Tf [( found no significant increase in VA or non-VA mental health services by those with previously )] TJ ET BT 26.250 236.574 Td /F1 9.8 Tf [(diagnosed PTSD. Others )] TJ ET 0.267 0.267 0.267 rg BT 137.341 238.082 Td /F4 8.7 Tf [(4)] TJ ET BT 142.160 238.082 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 146.979 236.574 Td /F1 9.8 Tf [( reported a decline in mental health and substance use services following Hurricane Katrina, )] TJ ET BT 26.250 224.670 Td /F1 9.8 Tf [(especially for those with PTSD. One possible explanation )] TJ ET 0.267 0.267 0.267 rg BT 276.065 226.177 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 280.883 224.670 Td /F1 9.8 Tf [( given for this decline in service use, despite its availability, was that )] TJ ET BT 26.250 212.765 Td /F1 9.8 Tf [(numbing and avoidance are symptoms of PTSD.)] TJ ET BT 26.250 193.360 Td /F1 9.8 Tf [(Regarding mental health functioning, veterans treated in PTSD clinics experienced fewer symptoms at admission after 9/11 )] TJ ET BT 26.250 181.455 Td /F1 9.8 Tf [(than veterans admitted before 9/11, contrary to expectations )] TJ ET 0.267 0.267 0.267 rg BT 289.100 182.963 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 293.919 181.455 Td /F1 9.8 Tf [(. Moreover, these veterans showed further improvement as time )] TJ ET BT 26.250 169.551 Td /F1 9.8 Tf [(went on after 9/11. Longitudinal research conducted among veterans pre- and post-9/11 shows that PTSD symptoms were )] TJ ET BT 26.250 157.646 Td /F1 9.8 Tf [(exacerbated immediately following 9/11, including avoidance/numbing and hyperarousal, but that these were not sustained over )] TJ ET BT 26.250 145.741 Td /F1 9.8 Tf [(time )] TJ ET 0.267 0.267 0.267 rg BT 47.378 147.248 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 52.197 145.741 Td /F1 9.8 Tf [( . In addition, research on the subjective experiences of veterans indicate that their thoughts and feelings about 9/11 )] TJ ET BT 26.250 133.836 Td /F1 9.8 Tf [(affected their overall functioning )] TJ ET 0.267 0.267 0.267 rg BT 166.611 135.344 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 171.430 133.836 Td /F1 9.8 Tf [(. Finally, regarding self-reports, people are generally consistent about reporting traumatic )] TJ ET BT 26.250 121.932 Td /F1 9.8 Tf [(events, particularly events related to PTSD )] TJ ET 0.267 0.267 0.267 rg BT 213.743 123.439 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 218.561 121.932 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 102.527 Td /F1 9.8 Tf [(In addition to examining PTSD, several studies considered general mental health issues. Following 9/11, there were increases )] TJ ET BT 26.250 90.622 Td /F1 9.8 Tf [(in unscheduled clinic visits by veterans for symptoms of anxiety and depression )] TJ ET 0.267 0.267 0.267 rg BT 371.429 92.129 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 376.248 90.622 Td /F1 9.8 Tf [(, which are linked with PTSD )] TJ ET 0.267 0.267 0.267 rg BT 503.037 92.129 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 512.674 90.622 Td /F1 9.8 Tf [(. Further, )] TJ ET BT 26.250 78.717 Td /F1 9.8 Tf [(veterans who experienced potentially traumatic events \(PTEs\) prior to Hurricane Katrina had increased likelihood of )] TJ ET BT 26.250 66.813 Td /F1 9.8 Tf [(experiencing violent PTEs during Katrina )] TJ ET 0.267 0.267 0.267 rg BT 205.075 68.320 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 214.712 66.813 Td /F1 9.8 Tf [(. Similarly, individuals with pre-Katrina mental illness showed higher levels of post-)] TJ ET BT 26.250 54.908 Td /F1 9.8 Tf [(Katrina cognitive bias, including negative interpretations and emotional responses to the disaster )] TJ ET 0.267 0.267 0.267 rg BT 445.159 56.415 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 454.796 54.908 Td /F1 9.8 Tf [(. Finally, an examination of )] TJ ET BT 26.250 43.003 Td /F1 9.8 Tf [(emotional distress among veterans following the 1994 Northridge Earthquake )] TJ ET 0.267 0.267 0.267 rg BT 362.235 44.510 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 371.872 43.003 Td /F1 9.8 Tf [(found that, similar to the above findings, pre-)] TJ ET Q q 15.000 28.717 577.500 748.283 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(research and practice. The categories on the data abstraction instrument reviewed in the current study included: 1. Study )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(design \(e.g., experimental including randomized groups and a control group, quasi-experimental including comparing different )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(groups under different conditions such as time periods or regions, or pre-experimental including examination of one group over )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(time, retrospective reporting, data tracking, program evaluation or descriptive case studies\); 2. Methodology \(i.e., qualitative, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(quantitative, mixed\); and 3. Role of VA in emergency management \(i.e. mitigation/prevention, preparedness, response, )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(recovery\). Two members of the research team independently reviewed the articles and compared data coded on the data )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(abstraction instrument. In cases where coding diverged, the team obtained reliability by reaching consensus about the code or )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(via input from a third team member. Finally, the articles were reviewed using content analysis techniques )] TJ ET 0.267 0.267 0.267 rg BT 480.337 685.650 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 485.155 684.143 Td /F1 9.8 Tf [( . The primary topic )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(of each article was characterized with a code word or phrase. Articles pertaining to similar topics were then grouped together )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(into categories described below.)] TJ ET 0.965 0.965 0.965 rg 26.250 432.298 555.000 218.155 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 650.453 m 581.250 650.453 l 581.250 649.703 l 26.250 649.703 l f 26.250 432.298 m 581.250 432.298 l 581.250 433.048 l 26.250 433.048 l f q 225.000 0 0 173.250 35.250 467.453 cm /I5 Do Q q 35.250 443.548 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 451.929 Td /F4 9.8 Tf [(Fig. 2: Data Abstraction Tool)] TJ ET Q BT 26.250 398.076 Td /F4 12.0 Tf [(RESULTS)] TJ ET BT 26.250 378.122 Td /F1 9.8 Tf [(The study design of the final group of articles was experimental \(n=0\), quasi-experimental \(n=12\) or pre-experimental \(n=29\). )] TJ ET BT 26.250 366.217 Td /F1 9.8 Tf [(Methodologies included qualitative \(n=21\), quantitative \(n=19\), and mixed \(n=1\). The role of VA in the emergency management )] TJ ET BT 26.250 354.312 Td /F1 9.8 Tf [(phases included mitigation/prevention \(n=5\), preparedness \(n=2\), response \(n=8\), or recovery \(n=14\). Several articles \(n= 12\) )] TJ ET BT 26.250 342.408 Td /F1 9.8 Tf [(addressed more than one emergency management role, including two articles that addressed all four roles.)] TJ ET BT 26.250 323.003 Td /F1 9.8 Tf [(Five topic categories emerged from the review: Effects of disaster on mental health status and services use, effects of disaster )] TJ ET BT 26.250 311.098 Td /F1 9.8 Tf [(on general health services use, patient tracking, evacuation, and disaster planning/preparation.)] TJ ET BT 26.250 291.693 Td /F4 9.8 Tf [(Effects of Disaster on Mental Health)] TJ ET BT 26.250 272.289 Td /F1 9.8 Tf [(Thirteen articles relate to the effects of disaster on mental health, including service use and status. Among studies that explored )] TJ ET BT 26.250 260.384 Td /F1 9.8 Tf [(mental healthcare use for PTSD symptoms )] TJ ET 0.267 0.267 0.267 rg BT 214.815 261.891 Td /F4 8.7 Tf [(2)] TJ ET BT 219.634 261.891 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 224.452 260.384 Td /F1 9.8 Tf [( one study )] TJ ET 0.267 0.267 0.267 rg BT 272.149 261.891 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 276.968 260.384 Td /F1 9.8 Tf [( found that the use of non-VA healthcare was likely to increase )] TJ ET BT 26.250 248.479 Td /F1 9.8 Tf [(following 9/11, while another )] TJ ET 0.267 0.267 0.267 rg BT 151.976 249.986 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 156.795 248.479 Td /F1 9.8 Tf [( found no significant increase in VA or non-VA mental health services by those with previously )] TJ ET BT 26.250 236.574 Td /F1 9.8 Tf [(diagnosed PTSD. Others )] TJ ET 0.267 0.267 0.267 rg BT 137.341 238.082 Td /F4 8.7 Tf [(4)] TJ ET BT 142.160 238.082 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 146.979 236.574 Td /F1 9.8 Tf [( reported a decline in mental health and substance use services following Hurricane Katrina, )] TJ ET BT 26.250 224.670 Td /F1 9.8 Tf [(especially for those with PTSD. One possible explanation )] TJ ET 0.267 0.267 0.267 rg BT 276.065 226.177 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 280.883 224.670 Td /F1 9.8 Tf [( given for this decline in service use, despite its availability, was that )] TJ ET BT 26.250 212.765 Td /F1 9.8 Tf [(numbing and avoidance are symptoms of PTSD.)] TJ ET BT 26.250 193.360 Td /F1 9.8 Tf [(Regarding mental health functioning, veterans treated in PTSD clinics experienced fewer symptoms at admission after 9/11 )] TJ ET BT 26.250 181.455 Td /F1 9.8 Tf [(than veterans admitted before 9/11, contrary to expectations )] TJ ET 0.267 0.267 0.267 rg BT 289.100 182.963 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 293.919 181.455 Td /F1 9.8 Tf [(. Moreover, these veterans showed further improvement as time )] TJ ET BT 26.250 169.551 Td /F1 9.8 Tf [(went on after 9/11. Longitudinal research conducted among veterans pre- and post-9/11 shows that PTSD symptoms were )] TJ ET BT 26.250 157.646 Td /F1 9.8 Tf [(exacerbated immediately following 9/11, including avoidance/numbing and hyperarousal, but that these were not sustained over )] TJ ET BT 26.250 145.741 Td /F1 9.8 Tf [(time )] TJ ET 0.267 0.267 0.267 rg BT 47.378 147.248 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 52.197 145.741 Td /F1 9.8 Tf [( . In addition, research on the subjective experiences of veterans indicate that their thoughts and feelings about 9/11 )] TJ ET BT 26.250 133.836 Td /F1 9.8 Tf [(affected their overall functioning )] TJ ET 0.267 0.267 0.267 rg BT 166.611 135.344 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 171.430 133.836 Td /F1 9.8 Tf [(. Finally, regarding self-reports, people are generally consistent about reporting traumatic )] TJ ET BT 26.250 121.932 Td /F1 9.8 Tf [(events, particularly events related to PTSD )] TJ ET 0.267 0.267 0.267 rg BT 213.743 123.439 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 218.561 121.932 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 102.527 Td /F1 9.8 Tf [(In addition to examining PTSD, several studies considered general mental health issues. Following 9/11, there were increases )] TJ ET BT 26.250 90.622 Td /F1 9.8 Tf [(in unscheduled clinic visits by veterans for symptoms of anxiety and depression )] TJ ET 0.267 0.267 0.267 rg BT 371.429 92.129 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 376.248 90.622 Td /F1 9.8 Tf [(, which are linked with PTSD )] TJ ET 0.267 0.267 0.267 rg BT 503.037 92.129 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 512.674 90.622 Td /F1 9.8 Tf [(. Further, )] TJ ET BT 26.250 78.717 Td /F1 9.8 Tf [(veterans who experienced potentially traumatic events \(PTEs\) prior to Hurricane Katrina had increased likelihood of )] TJ ET BT 26.250 66.813 Td /F1 9.8 Tf [(experiencing violent PTEs during Katrina )] TJ ET 0.267 0.267 0.267 rg BT 205.075 68.320 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 214.712 66.813 Td /F1 9.8 Tf [(. Similarly, individuals with pre-Katrina mental illness showed higher levels of post-)] TJ ET BT 26.250 54.908 Td /F1 9.8 Tf [(Katrina cognitive bias, including negative interpretations and emotional responses to the disaster )] TJ ET 0.267 0.267 0.267 rg BT 445.159 56.415 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 454.796 54.908 Td /F1 9.8 Tf [(. Finally, an examination of )] TJ ET BT 26.250 43.003 Td /F1 9.8 Tf [(emotional distress among veterans following the 1994 Northridge Earthquake )] TJ ET 0.267 0.267 0.267 rg BT 362.235 44.510 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 371.872 43.003 Td /F1 9.8 Tf [(found that, similar to the above findings, pre-)] TJ ET Q q 15.000 28.717 577.500 748.283 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(research and practice. The categories on the data abstraction instrument reviewed in the current study included: 1. Study )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(design \(e.g., experimental including randomized groups and a control group, quasi-experimental including comparing different )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(groups under different conditions such as time periods or regions, or pre-experimental including examination of one group over )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(time, retrospective reporting, data tracking, program evaluation or descriptive case studies\); 2. Methodology \(i.e., qualitative, )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(quantitative, mixed\); and 3. Role of VA in emergency management \(i.e. mitigation/prevention, preparedness, response, )] TJ ET BT 26.250 707.952 Td /F1 9.8 Tf [(recovery\). Two members of the research team independently reviewed the articles and compared data coded on the data )] TJ ET BT 26.250 696.048 Td /F1 9.8 Tf [(abstraction instrument. In cases where coding diverged, the team obtained reliability by reaching consensus about the code or )] TJ ET BT 26.250 684.143 Td /F1 9.8 Tf [(via input from a third team member. Finally, the articles were reviewed using content analysis techniques )] TJ ET 0.267 0.267 0.267 rg BT 480.337 685.650 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 485.155 684.143 Td /F1 9.8 Tf [( . The primary topic )] TJ ET BT 26.250 672.238 Td /F1 9.8 Tf [(of each article was characterized with a code word or phrase. Articles pertaining to similar topics were then grouped together )] TJ ET BT 26.250 660.333 Td /F1 9.8 Tf [(into categories described below.)] TJ ET 0.965 0.965 0.965 rg 26.250 432.298 555.000 218.155 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 650.453 m 581.250 650.453 l 581.250 649.703 l 26.250 649.703 l f 26.250 432.298 m 581.250 432.298 l 581.250 433.048 l 26.250 433.048 l f q 225.000 0 0 173.250 35.250 467.453 cm /I5 Do Q q 35.250 443.548 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 451.929 Td /F4 9.8 Tf [(Fig. 2: Data Abstraction Tool)] TJ ET Q BT 26.250 398.076 Td /F4 12.0 Tf [(RESULTS)] TJ ET BT 26.250 378.122 Td /F1 9.8 Tf [(The study design of the final group of articles was experimental \(n=0\), quasi-experimental \(n=12\) or pre-experimental \(n=29\). )] TJ ET BT 26.250 366.217 Td /F1 9.8 Tf [(Methodologies included qualitative \(n=21\), quantitative \(n=19\), and mixed \(n=1\). The role of VA in the emergency management )] TJ ET BT 26.250 354.312 Td /F1 9.8 Tf [(phases included mitigation/prevention \(n=5\), preparedness \(n=2\), response \(n=8\), or recovery \(n=14\). Several articles \(n= 12\) )] TJ ET BT 26.250 342.408 Td /F1 9.8 Tf [(addressed more than one emergency management role, including two articles that addressed all four roles.)] TJ ET BT 26.250 323.003 Td /F1 9.8 Tf [(Five topic categories emerged from the review: Effects of disaster on mental health status and services use, effects of disaster )] TJ ET BT 26.250 311.098 Td /F1 9.8 Tf [(on general health services use, patient tracking, evacuation, and disaster planning/preparation.)] TJ ET BT 26.250 291.693 Td /F4 9.8 Tf [(Effects of Disaster on Mental Health)] TJ ET BT 26.250 272.289 Td /F1 9.8 Tf [(Thirteen articles relate to the effects of disaster on mental health, including service use and status. Among studies that explored )] TJ ET BT 26.250 260.384 Td /F1 9.8 Tf [(mental healthcare use for PTSD symptoms )] TJ ET 0.267 0.267 0.267 rg BT 214.815 261.891 Td /F4 8.7 Tf [(2)] TJ ET BT 219.634 261.891 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 224.452 260.384 Td /F1 9.8 Tf [( one study )] TJ ET 0.267 0.267 0.267 rg BT 272.149 261.891 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 276.968 260.384 Td /F1 9.8 Tf [( found that the use of non-VA healthcare was likely to increase )] TJ ET BT 26.250 248.479 Td /F1 9.8 Tf [(following 9/11, while another )] TJ ET 0.267 0.267 0.267 rg BT 151.976 249.986 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 156.795 248.479 Td /F1 9.8 Tf [( found no significant increase in VA or non-VA mental health services by those with previously )] TJ ET BT 26.250 236.574 Td /F1 9.8 Tf [(diagnosed PTSD. Others )] TJ ET 0.267 0.267 0.267 rg BT 137.341 238.082 Td /F4 8.7 Tf [(4)] TJ ET BT 142.160 238.082 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 146.979 236.574 Td /F1 9.8 Tf [( reported a decline in mental health and substance use services following Hurricane Katrina, )] TJ ET BT 26.250 224.670 Td /F1 9.8 Tf [(especially for those with PTSD. One possible explanation )] TJ ET 0.267 0.267 0.267 rg BT 276.065 226.177 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 280.883 224.670 Td /F1 9.8 Tf [( given for this decline in service use, despite its availability, was that )] TJ ET BT 26.250 212.765 Td /F1 9.8 Tf [(numbing and avoidance are symptoms of PTSD.)] TJ ET BT 26.250 193.360 Td /F1 9.8 Tf [(Regarding mental health functioning, veterans treated in PTSD clinics experienced fewer symptoms at admission after 9/11 )] TJ ET BT 26.250 181.455 Td /F1 9.8 Tf [(than veterans admitted before 9/11, contrary to expectations )] TJ ET 0.267 0.267 0.267 rg BT 289.100 182.963 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 293.919 181.455 Td /F1 9.8 Tf [(. Moreover, these veterans showed further improvement as time )] TJ ET BT 26.250 169.551 Td /F1 9.8 Tf [(went on after 9/11. Longitudinal research conducted among veterans pre- and post-9/11 shows that PTSD symptoms were )] TJ ET BT 26.250 157.646 Td /F1 9.8 Tf [(exacerbated immediately following 9/11, including avoidance/numbing and hyperarousal, but that these were not sustained over )] TJ ET BT 26.250 145.741 Td /F1 9.8 Tf [(time )] TJ ET 0.267 0.267 0.267 rg BT 47.378 147.248 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 52.197 145.741 Td /F1 9.8 Tf [( . In addition, research on the subjective experiences of veterans indicate that their thoughts and feelings about 9/11 )] TJ ET BT 26.250 133.836 Td /F1 9.8 Tf [(affected their overall functioning )] TJ ET 0.267 0.267 0.267 rg BT 166.611 135.344 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 171.430 133.836 Td /F1 9.8 Tf [(. Finally, regarding self-reports, people are generally consistent about reporting traumatic )] TJ ET BT 26.250 121.932 Td /F1 9.8 Tf [(events, particularly events related to PTSD )] TJ ET 0.267 0.267 0.267 rg BT 213.743 123.439 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 218.561 121.932 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 102.527 Td /F1 9.8 Tf [(In addition to examining PTSD, several studies considered general mental health issues. Following 9/11, there were increases )] TJ ET BT 26.250 90.622 Td /F1 9.8 Tf [(in unscheduled clinic visits by veterans for symptoms of anxiety and depression )] TJ ET 0.267 0.267 0.267 rg BT 371.429 92.129 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 376.248 90.622 Td /F1 9.8 Tf [(, which are linked with PTSD )] TJ ET 0.267 0.267 0.267 rg BT 503.037 92.129 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 512.674 90.622 Td /F1 9.8 Tf [(. Further, )] TJ ET BT 26.250 78.717 Td /F1 9.8 Tf [(veterans who experienced potentially traumatic events \(PTEs\) prior to Hurricane Katrina had increased likelihood of )] TJ ET BT 26.250 66.813 Td /F1 9.8 Tf [(experiencing violent PTEs during Katrina )] TJ ET 0.267 0.267 0.267 rg BT 205.075 68.320 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 214.712 66.813 Td /F1 9.8 Tf [(. Similarly, individuals with pre-Katrina mental illness showed higher levels of post-)] TJ ET BT 26.250 54.908 Td /F1 9.8 Tf [(Katrina cognitive bias, including negative interpretations and emotional responses to the disaster )] TJ ET 0.267 0.267 0.267 rg BT 445.159 56.415 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 454.796 54.908 Td /F1 9.8 Tf [(. 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TJ ET 0.267 0.267 0.267 rg BT 332.429 757.079 Td /F4 8.7 Tf [(13)] TJ ET BT 342.067 757.079 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 351.704 755.571 Td /F1 9.8 Tf [(, especially veterans of low socioeconomic status )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(and minority groups. 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Characteristics such as interdisciplinary collaboration and support of )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(medication counseling from VA and non-VA local pharmacists have been shown to mitigate the challenges )] TJ ET 0.267 0.267 0.267 rg BT 487.961 658.745 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 497.599 657.238 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(Despite challenges and uncertainty, VA facilities, mobile clinics, and a VA Disaster Application Center \(DAC\) successfully )] TJ ET BT 26.250 625.929 Td /F1 9.8 Tf [(served veterans and non-veterans alike in the first days following a disaster. Mobile clinics were effective because veterans )] TJ ET BT 26.250 614.024 Td /F1 9.8 Tf [(favored receiving medical care in their communities, but the availability of care through mobile clinics presented the challenge of )] TJ ET BT 26.250 602.119 Td /F1 9.8 Tf [(treating non-routine populations, such as infants and children. 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One example is the Acute Traumatic Stress Management )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(Protocol, which emphasized primary prevention for survivors of a disaster \(e.g., immunizations to protect victims from )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(communicable diseases\) )] TJ ET 0.267 0.267 0.267 rg BT 136.240 544.103 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 145.877 542.595 Td /F1 9.8 Tf [(. Irrespective of the care provided, it is argued that healthcare providers should engage in evidence-)] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(based practice to avoid perpetuating misperceptions of unnecessary healthcare needs by the public due to uncertainty caused )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(by a disaster )] TJ ET 0.267 0.267 0.267 rg BT 84.233 520.293 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 93.871 518.786 Td /F1 9.8 Tf [(. In addition, chronic pain and diabetes management services )] TJ ET 0.267 0.267 0.267 rg BT 361.586 520.293 Td /F4 8.7 Tf [(20)] TJ ET BT 371.223 520.293 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 380.861 518.786 Td /F1 9.8 Tf [( and services for veterans with spinal cord )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(injuries and disorders )] TJ ET 0.267 0.267 0.267 rg BT 121.615 508.388 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 131.252 506.881 Td /F1 9.8 Tf [( were affected by considerable barriers after a disaster highlights the need for better coordination )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(between clinics and specialists.)] TJ ET BT 26.250 475.572 Td /F4 9.8 Tf [(Patient Tracking)] TJ ET BT 26.250 456.167 Td /F1 9.8 Tf [(Three articles emphasize the importance of emergency medical records for optimizing service provision. One case study )] TJ ET 0.267 0.267 0.267 rg BT 547.514 457.674 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 26.250 444.262 Td /F1 9.8 Tf [(describes the paper-based medical record system employed after the Northridge Earthquake used by all of the medical stations, )] TJ ET BT 26.250 432.357 Td /F1 9.8 Tf [(disaster action centers and mobile clinics deployed after the earthquake. The authors attribute their ability to provide care to )] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(more than 11,000 disaster victims to an organized system that used simple forms, was consistent across providers and )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(locations, had a central data collection point, made records available and accessible to providers at a known site every 12 hours )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(and required the transfer of medical records with the patient. 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Despite the widespread adoption of CPRS throughout VA, electricity and )] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(computers are not always available at the site of a disaster. A pharmacist describes his experience of serving victims of the )] TJ ET BT 26.250 313.310 Td /F1 9.8 Tf [(Northridge earthquake without computer \(and CPRS\) access until two weeks following the event )] TJ ET 0.267 0.267 0.267 rg BT 443.501 314.817 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 453.139 313.310 Td /F1 9.8 Tf [(. He describes a process of )] TJ ET BT 26.250 301.405 Td /F1 9.8 Tf [(keeping a logbook and handwriting medication labels until CPRS became available. These articles serve as a reminder that )] TJ ET BT 26.250 289.500 Td /F1 9.8 Tf [(ongoing tracking of patients before and after a disaster plays a key role in successful response.)] TJ ET BT 26.250 270.096 Td /F4 9.8 Tf [(Evacuation)] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(The five case studies about evacuation following a major disaster share several characteristics and lessons learned while each )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(report includes experiences unique to the particular evacuation. There is a clear need for prompt decisions made by the )] TJ ET BT 26.250 226.881 Td /F1 9.8 Tf [(administration, coupled with an understanding of the chain of command by all involved in the disaster response )] TJ ET 0.267 0.267 0.267 rg BT 506.935 228.389 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 516.572 226.881 Td /F1 9.8 Tf [(. 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The )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(availability of manpower was discussed as critical to the success of an evacuation )] TJ ET 0.267 0.267 0.267 rg BT 381.725 168.865 Td /F4 8.7 Tf [(25)] TJ ET BT 391.363 168.865 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 401.000 167.358 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 147.953 Td /F1 9.8 Tf [(Working with the community was another topic of importance within evacuation. 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The unavailability of )] TJ ET BT 26.250 100.334 Td /F1 9.8 Tf [(means of communication may have hampered use of community resources. A loss of or hindered communication was )] TJ ET BT 26.250 88.429 Td /F1 9.8 Tf [(mentioned in all of the articles as problematic during evacuation. In particular a loss of emergency medical record access )] TJ ET BT 26.250 76.524 Td /F1 9.8 Tf [(through VAs CPRS, which compromised access to real time data, was noted.)] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(Continuity of care, as shown in two studies, was not compromised because providers made an effort to follow patients that had )] TJ ET BT 26.250 45.215 Td /F1 9.8 Tf [(been transferred to another hospital due to a loss of utilities and potential explosion )] TJ ET 0.267 0.267 0.267 rg BT 387.195 46.722 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 396.832 45.215 Td /F1 9.8 Tf [( and internal flooding )] TJ ET 0.267 0.267 0.267 rg BT 490.052 46.722 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 499.689 45.215 Td /F1 9.8 Tf [(. Challenges to )] TJ ET Q q 15.000 30.929 577.500 746.071 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(disaster emotional status was a strong predictor of individual perception of earthquake impact, as well as post-disaster distress. )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(Findings make salient the impact of disaster on vulnerable populations )] TJ ET 0.267 0.267 0.267 rg BT 332.429 757.079 Td /F4 8.7 Tf [(13)] TJ ET BT 342.067 757.079 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 351.704 755.571 Td /F1 9.8 Tf [(, especially veterans of low socioeconomic status )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(and minority groups. Overall, these studies point to the importance of outreach and service provision to disaster survivors who )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(struggle with or are at risk for emotional illness following disasters.)] TJ ET BT 26.250 712.357 Td /F4 9.8 Tf [(Effects of Disaster on General Health Services Use)] TJ ET BT 26.250 692.952 Td /F1 9.8 Tf [(Eight studies address general health services use affected by disaster. From the providers perspective, it is challenging to )] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(provide continuity of care because of several barriers including limited or compromised communication infrastructure )] TJ ET 0.267 0.267 0.267 rg BT 530.169 682.555 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 539.806 681.048 Td /F1 9.8 Tf [(, lack of )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(records )] TJ ET 0.267 0.267 0.267 rg BT 61.467 670.650 Td /F4 8.7 Tf [(15)] TJ ET BT 71.104 670.650 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 80.742 669.143 Td /F1 9.8 Tf [( and uncertainty regarding best practices )] TJ ET 0.267 0.267 0.267 rg BT 259.576 670.650 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 269.214 669.143 Td /F1 9.8 Tf [(. Characteristics such as interdisciplinary collaboration and support of )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(medication counseling from VA and non-VA local pharmacists have been shown to mitigate the challenges )] TJ ET 0.267 0.267 0.267 rg BT 487.961 658.745 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 497.599 657.238 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(Despite challenges and uncertainty, VA facilities, mobile clinics, and a VA Disaster Application Center \(DAC\) successfully )] TJ ET BT 26.250 625.929 Td /F1 9.8 Tf [(served veterans and non-veterans alike in the first days following a disaster. Mobile clinics were effective because veterans )] TJ ET BT 26.250 614.024 Td /F1 9.8 Tf [(favored receiving medical care in their communities, but the availability of care through mobile clinics presented the challenge of )] TJ ET BT 26.250 602.119 Td /F1 9.8 Tf [(treating non-routine populations, such as infants and children. Volunteer practitioners should be thus versed in treating pediatric )] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(patients and knowledgeable about types of post-disaster conditions they would likely treat through the mobile clinic and DAC )] TJ ET 0.267 0.267 0.267 rg BT 564.918 591.722 Td /F4 8.7 Tf [(16)] TJ ET BT 26.250 579.817 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 35.887 578.310 Td /F1 9.8 Tf [(. Despite reports of effective response immediately following the disaster, there was a call for increased provision of follow-up )] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(healthcare services after the first 72 hours following disaster )] TJ ET 0.267 0.267 0.267 rg BT 287.979 567.912 Td /F4 8.7 Tf [(15)] TJ ET BT 297.616 567.912 Td /F4 8.7 Tf [(16)] TJ ET BT 307.254 567.912 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 316.891 566.405 Td /F1 9.8 Tf [(. One example is the Acute Traumatic Stress Management )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(Protocol, which emphasized primary prevention for survivors of a disaster \(e.g., immunizations to protect victims from )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(communicable diseases\) )] TJ ET 0.267 0.267 0.267 rg BT 136.240 544.103 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 145.877 542.595 Td /F1 9.8 Tf [(. Irrespective of the care provided, it is argued that healthcare providers should engage in evidence-)] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(based practice to avoid perpetuating misperceptions of unnecessary healthcare needs by the public due to uncertainty caused )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(by a disaster )] TJ ET 0.267 0.267 0.267 rg BT 84.233 520.293 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 93.871 518.786 Td /F1 9.8 Tf [(. In addition, chronic pain and diabetes management services )] TJ ET 0.267 0.267 0.267 rg BT 361.586 520.293 Td /F4 8.7 Tf [(20)] TJ ET BT 371.223 520.293 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 380.861 518.786 Td /F1 9.8 Tf [( and services for veterans with spinal cord )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(injuries and disorders )] TJ ET 0.267 0.267 0.267 rg BT 121.615 508.388 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 131.252 506.881 Td /F1 9.8 Tf [( were affected by considerable barriers after a disaster highlights the need for better coordination )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(between clinics and specialists.)] TJ ET BT 26.250 475.572 Td /F4 9.8 Tf [(Patient Tracking)] TJ ET BT 26.250 456.167 Td /F1 9.8 Tf [(Three articles emphasize the importance of emergency medical records for optimizing service provision. One case study )] TJ ET 0.267 0.267 0.267 rg BT 547.514 457.674 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 26.250 444.262 Td /F1 9.8 Tf [(describes the paper-based medical record system employed after the Northridge Earthquake used by all of the medical stations, )] TJ ET BT 26.250 432.357 Td /F1 9.8 Tf [(disaster action centers and mobile clinics deployed after the earthquake. The authors attribute their ability to provide care to )] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(more than 11,000 disaster victims to an organized system that used simple forms, was consistent across providers and )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(locations, had a central data collection point, made records available and accessible to providers at a known site every 12 hours )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(and required the transfer of medical records with the patient. Prior to the Northridge earthquake, published information about )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(data collection during a disaster was particularly sparse. Ten years later the VA Computerized Patient Record System \(CPRS\) )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(was implemented, technology that made it possible for every VA provider across the nation to access any veterans health care )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(records, was released and is credited with making the VA response to Hurricane Katrina a successful one. CPRS supported )] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(continuity of care because the electronic medical records included not only prescriptions and lab results, but also case notes )] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(and other documents critical to care provision )] TJ ET 0.267 0.267 0.267 rg BT 225.121 338.627 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 234.758 337.119 Td /F1 9.8 Tf [(. Despite the widespread adoption of CPRS throughout VA, electricity and )] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(computers are not always available at the site of a disaster. A pharmacist describes his experience of serving victims of the )] TJ ET BT 26.250 313.310 Td /F1 9.8 Tf [(Northridge earthquake without computer \(and CPRS\) access until two weeks following the event )] TJ ET 0.267 0.267 0.267 rg BT 443.501 314.817 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 453.139 313.310 Td /F1 9.8 Tf [(. He describes a process of )] TJ ET BT 26.250 301.405 Td /F1 9.8 Tf [(keeping a logbook and handwriting medication labels until CPRS became available. These articles serve as a reminder that )] TJ ET BT 26.250 289.500 Td /F1 9.8 Tf [(ongoing tracking of patients before and after a disaster plays a key role in successful response.)] TJ ET BT 26.250 270.096 Td /F4 9.8 Tf [(Evacuation)] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(The five case studies about evacuation following a major disaster share several characteristics and lessons learned while each )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(report includes experiences unique to the particular evacuation. There is a clear need for prompt decisions made by the )] TJ ET BT 26.250 226.881 Td /F1 9.8 Tf [(administration, coupled with an understanding of the chain of command by all involved in the disaster response )] TJ ET 0.267 0.267 0.267 rg BT 506.935 228.389 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 516.572 226.881 Td /F1 9.8 Tf [(. In some )] TJ ET BT 26.250 214.977 Td /F1 9.8 Tf [(cases, administrators may not be available, so staff should be empowered to make decisions, if necessary. Moreover, the )] TJ ET BT 26.250 203.072 Td /F1 9.8 Tf [(normal chain of command needs to be modified in the case of a disaster )] TJ ET 0.267 0.267 0.267 rg BT 340.024 204.579 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 349.662 203.072 Td /F1 9.8 Tf [(. There was a call for a redefinition of essential )] TJ ET BT 26.250 191.167 Td /F1 9.8 Tf [(personnel during a disaster, placing emphasis on the importance of facilities management for tasks such as laundering and )] TJ ET BT 26.250 179.262 Td /F1 9.8 Tf [(those with experience arranging transfer of patients, such as social workers, case managers and medical administrators )] TJ ET 0.267 0.267 0.267 rg BT 545.369 180.770 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 555.007 179.262 Td /F1 9.8 Tf [(. The )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(availability of manpower was discussed as critical to the success of an evacuation )] TJ ET 0.267 0.267 0.267 rg BT 381.725 168.865 Td /F4 8.7 Tf [(25)] TJ ET BT 391.363 168.865 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 401.000 167.358 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 147.953 Td /F1 9.8 Tf [(Working with the community was another topic of importance within evacuation. Pre-existing agreements with community )] TJ ET BT 26.250 136.048 Td /F1 9.8 Tf [(resources and hospital facilities that could host evacuated veterans was cited as critical to the evacuation )] TJ ET 0.267 0.267 0.267 rg BT 482.004 137.555 Td /F4 8.7 Tf [(26)] TJ ET BT 491.641 137.555 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 501.279 136.048 Td /F1 9.8 Tf [(, as was on-the-)] TJ ET BT 26.250 124.143 Td /F1 9.8 Tf [(spot collaboration with local entities, such as the fire department and other medical centers )] TJ ET 0.267 0.267 0.267 rg BT 420.218 125.651 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 429.856 124.143 Td /F1 9.8 Tf [(. It was noted in one case )] TJ ET 0.267 0.267 0.267 rg BT 543.131 125.651 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 552.768 124.143 Td /F1 9.8 Tf [(, )] TJ ET BT 26.250 112.239 Td /F1 9.8 Tf [(though, that despite pre-arrangements with local hospitals, the plan was negated by local city government. The unavailability of )] TJ ET BT 26.250 100.334 Td /F1 9.8 Tf [(means of communication may have hampered use of community resources. A loss of or hindered communication was )] TJ ET BT 26.250 88.429 Td /F1 9.8 Tf [(mentioned in all of the articles as problematic during evacuation. In particular a loss of emergency medical record access )] TJ ET BT 26.250 76.524 Td /F1 9.8 Tf [(through VAs CPRS, which compromised access to real time data, was noted.)] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(Continuity of care, as shown in two studies, was not compromised because providers made an effort to follow patients that had )] TJ ET BT 26.250 45.215 Td /F1 9.8 Tf [(been transferred to another hospital due to a loss of utilities and potential explosion )] TJ ET 0.267 0.267 0.267 rg BT 387.195 46.722 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 396.832 45.215 Td /F1 9.8 Tf [( and internal flooding )] TJ ET 0.267 0.267 0.267 rg BT 490.052 46.722 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 499.689 45.215 Td /F1 9.8 Tf [(. Challenges to )] TJ ET Q q 15.000 30.929 577.500 746.071 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(disaster emotional status was a strong predictor of individual perception of earthquake impact, as well as post-disaster distress. )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(Findings make salient the impact of disaster on vulnerable populations )] TJ ET 0.267 0.267 0.267 rg BT 332.429 757.079 Td /F4 8.7 Tf [(13)] TJ ET BT 342.067 757.079 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 351.704 755.571 Td /F1 9.8 Tf [(, especially veterans of low socioeconomic status )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(and minority groups. Overall, these studies point to the importance of outreach and service provision to disaster survivors who )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(struggle with or are at risk for emotional illness following disasters.)] TJ ET BT 26.250 712.357 Td /F4 9.8 Tf [(Effects of Disaster on General Health Services Use)] TJ ET BT 26.250 692.952 Td /F1 9.8 Tf [(Eight studies address general health services use affected by disaster. From the providers perspective, it is challenging to )] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(provide continuity of care because of several barriers including limited or compromised communication infrastructure )] TJ ET 0.267 0.267 0.267 rg BT 530.169 682.555 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 539.806 681.048 Td /F1 9.8 Tf [(, lack of )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(records )] TJ ET 0.267 0.267 0.267 rg BT 61.467 670.650 Td /F4 8.7 Tf [(15)] TJ ET BT 71.104 670.650 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 80.742 669.143 Td /F1 9.8 Tf [( and uncertainty regarding best practices )] TJ ET 0.267 0.267 0.267 rg BT 259.576 670.650 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 269.214 669.143 Td /F1 9.8 Tf [(. Characteristics such as interdisciplinary collaboration and support of )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(medication counseling from VA and non-VA local pharmacists have been shown to mitigate the challenges )] TJ ET 0.267 0.267 0.267 rg BT 487.961 658.745 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 497.599 657.238 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(Despite challenges and uncertainty, VA facilities, mobile clinics, and a VA Disaster Application Center \(DAC\) successfully )] TJ ET BT 26.250 625.929 Td /F1 9.8 Tf [(served veterans and non-veterans alike in the first days following a disaster. Mobile clinics were effective because veterans )] TJ ET BT 26.250 614.024 Td /F1 9.8 Tf [(favored receiving medical care in their communities, but the availability of care through mobile clinics presented the challenge of )] TJ ET BT 26.250 602.119 Td /F1 9.8 Tf [(treating non-routine populations, such as infants and children. Volunteer practitioners should be thus versed in treating pediatric )] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(patients and knowledgeable about types of post-disaster conditions they would likely treat through the mobile clinic and DAC )] TJ ET 0.267 0.267 0.267 rg BT 564.918 591.722 Td /F4 8.7 Tf [(16)] TJ ET BT 26.250 579.817 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 35.887 578.310 Td /F1 9.8 Tf [(. Despite reports of effective response immediately following the disaster, there was a call for increased provision of follow-up )] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(healthcare services after the first 72 hours following disaster )] TJ ET 0.267 0.267 0.267 rg BT 287.979 567.912 Td /F4 8.7 Tf [(15)] TJ ET BT 297.616 567.912 Td /F4 8.7 Tf [(16)] TJ ET BT 307.254 567.912 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 316.891 566.405 Td /F1 9.8 Tf [(. One example is the Acute Traumatic Stress Management )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(Protocol, which emphasized primary prevention for survivors of a disaster \(e.g., immunizations to protect victims from )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(communicable diseases\) )] TJ ET 0.267 0.267 0.267 rg BT 136.240 544.103 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 145.877 542.595 Td /F1 9.8 Tf [(. Irrespective of the care provided, it is argued that healthcare providers should engage in evidence-)] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(based practice to avoid perpetuating misperceptions of unnecessary healthcare needs by the public due to uncertainty caused )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(by a disaster )] TJ ET 0.267 0.267 0.267 rg BT 84.233 520.293 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 93.871 518.786 Td /F1 9.8 Tf [(. In addition, chronic pain and diabetes management services )] TJ ET 0.267 0.267 0.267 rg BT 361.586 520.293 Td /F4 8.7 Tf [(20)] TJ ET BT 371.223 520.293 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 380.861 518.786 Td /F1 9.8 Tf [( and services for veterans with spinal cord )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(injuries and disorders )] TJ ET 0.267 0.267 0.267 rg BT 121.615 508.388 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 131.252 506.881 Td /F1 9.8 Tf [( were affected by considerable barriers after a disaster highlights the need for better coordination )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(between clinics and specialists.)] TJ ET BT 26.250 475.572 Td /F4 9.8 Tf [(Patient Tracking)] TJ ET BT 26.250 456.167 Td /F1 9.8 Tf [(Three articles emphasize the importance of emergency medical records for optimizing service provision. One case study )] TJ ET 0.267 0.267 0.267 rg BT 547.514 457.674 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 26.250 444.262 Td /F1 9.8 Tf [(describes the paper-based medical record system employed after the Northridge Earthquake used by all of the medical stations, )] TJ ET BT 26.250 432.357 Td /F1 9.8 Tf [(disaster action centers and mobile clinics deployed after the earthquake. The authors attribute their ability to provide care to )] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(more than 11,000 disaster victims to an organized system that used simple forms, was consistent across providers and )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(locations, had a central data collection point, made records available and accessible to providers at a known site every 12 hours )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(and required the transfer of medical records with the patient. Prior to the Northridge earthquake, published information about )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(data collection during a disaster was particularly sparse. Ten years later the VA Computerized Patient Record System \(CPRS\) )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(was implemented, technology that made it possible for every VA provider across the nation to access any veterans health care )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(records, was released and is credited with making the VA response to Hurricane Katrina a successful one. CPRS supported )] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(continuity of care because the electronic medical records included not only prescriptions and lab results, but also case notes )] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(and other documents critical to care provision )] TJ ET 0.267 0.267 0.267 rg BT 225.121 338.627 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 234.758 337.119 Td /F1 9.8 Tf [(. Despite the widespread adoption of CPRS throughout VA, electricity and )] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(computers are not always available at the site of a disaster. A pharmacist describes his experience of serving victims of the )] TJ ET BT 26.250 313.310 Td /F1 9.8 Tf [(Northridge earthquake without computer \(and CPRS\) access until two weeks following the event )] TJ ET 0.267 0.267 0.267 rg BT 443.501 314.817 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 453.139 313.310 Td /F1 9.8 Tf [(. He describes a process of )] TJ ET BT 26.250 301.405 Td /F1 9.8 Tf [(keeping a logbook and handwriting medication labels until CPRS became available. These articles serve as a reminder that )] TJ ET BT 26.250 289.500 Td /F1 9.8 Tf [(ongoing tracking of patients before and after a disaster plays a key role in successful response.)] TJ ET BT 26.250 270.096 Td /F4 9.8 Tf [(Evacuation)] TJ ET BT 26.250 250.691 Td /F1 9.8 Tf [(The five case studies about evacuation following a major disaster share several characteristics and lessons learned while each )] TJ ET BT 26.250 238.786 Td /F1 9.8 Tf [(report includes experiences unique to the particular evacuation. There is a clear need for prompt decisions made by the )] TJ ET BT 26.250 226.881 Td /F1 9.8 Tf [(administration, coupled with an understanding of the chain of command by all involved in the disaster response )] TJ ET 0.267 0.267 0.267 rg BT 506.935 228.389 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 516.572 226.881 Td /F1 9.8 Tf [(. In some )] TJ ET BT 26.250 214.977 Td /F1 9.8 Tf [(cases, administrators may not be available, so staff should be empowered to make decisions, if necessary. Moreover, the )] TJ ET BT 26.250 203.072 Td /F1 9.8 Tf [(normal chain of command needs to be modified in the case of a disaster )] TJ ET 0.267 0.267 0.267 rg BT 340.024 204.579 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 349.662 203.072 Td /F1 9.8 Tf [(. There was a call for a redefinition of essential )] TJ ET BT 26.250 191.167 Td /F1 9.8 Tf [(personnel during a disaster, placing emphasis on the importance of facilities management for tasks such as laundering and )] TJ ET BT 26.250 179.262 Td /F1 9.8 Tf [(those with experience arranging transfer of patients, such as social workers, case managers and medical administrators )] TJ ET 0.267 0.267 0.267 rg BT 545.369 180.770 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 555.007 179.262 Td /F1 9.8 Tf [(. The )] TJ ET BT 26.250 167.358 Td /F1 9.8 Tf [(availability of manpower was discussed as critical to the success of an evacuation )] TJ ET 0.267 0.267 0.267 rg BT 381.725 168.865 Td /F4 8.7 Tf [(25)] TJ ET BT 391.363 168.865 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 401.000 167.358 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 147.953 Td /F1 9.8 Tf [(Working with the community was another topic of importance within evacuation. Pre-existing agreements with community )] TJ ET BT 26.250 136.048 Td /F1 9.8 Tf [(resources and hospital facilities that could host evacuated veterans was cited as critical to the evacuation )] TJ ET 0.267 0.267 0.267 rg BT 482.004 137.555 Td /F4 8.7 Tf [(26)] TJ ET BT 491.641 137.555 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 501.279 136.048 Td /F1 9.8 Tf [(, as was on-the-)] TJ ET BT 26.250 124.143 Td /F1 9.8 Tf [(spot collaboration with local entities, such as the fire department and other medical centers )] TJ ET 0.267 0.267 0.267 rg BT 420.218 125.651 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 429.856 124.143 Td /F1 9.8 Tf [(. It was noted in one case )] TJ ET 0.267 0.267 0.267 rg BT 543.131 125.651 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 552.768 124.143 Td /F1 9.8 Tf [(, )] TJ ET BT 26.250 112.239 Td /F1 9.8 Tf [(though, that despite pre-arrangements with local hospitals, the plan was negated by local city government. The unavailability of )] TJ ET BT 26.250 100.334 Td /F1 9.8 Tf [(means of communication may have hampered use of community resources. A loss of or hindered communication was )] TJ ET BT 26.250 88.429 Td /F1 9.8 Tf [(mentioned in all of the articles as problematic during evacuation. In particular a loss of emergency medical record access )] TJ ET BT 26.250 76.524 Td /F1 9.8 Tf [(through VAs CPRS, which compromised access to real time data, was noted.)] TJ ET BT 26.250 57.120 Td /F1 9.8 Tf [(Continuity of care, as shown in two studies, was not compromised because providers made an effort to follow patients that had )] TJ ET BT 26.250 45.215 Td /F1 9.8 Tf [(been transferred to another hospital due to a loss of utilities and potential explosion )] TJ ET 0.267 0.267 0.267 rg BT 387.195 46.722 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 396.832 45.215 Td /F1 9.8 Tf [( and internal flooding )] TJ ET 0.267 0.267 0.267 rg BT 490.052 46.722 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 499.689 45.215 Td /F1 9.8 Tf [(. 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The proposed framework was designed to address the comprehensive needs of patients )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(during evacuation, including the role of the community, as well as highlight the significance of communication and collaboration )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(with federal, state, and local emergency entities. Similar to the above articles, it addresses the role of the community and )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(coordination of services necessary for successful short-term and long-term evacuation-related outcomes that moved above and )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(beyond temporary evacuation to consider the need for permanent evacuations, especially for vulnerable nursing home )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(residents. Overall, all of the articles point to the need for continued evidence-based studies on evacuation preparedness and )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(response.)] TJ ET BT 26.250 566.405 Td /F4 9.8 Tf [(Disaster Planning/Preparedness)] TJ ET BT 26.250 547.000 Td /F1 9.8 Tf [(Twelve of the included articles are about disaster planning and preparedness. These articles covered a wide variety of )] TJ ET BT 26.250 535.095 Td /F1 9.8 Tf [(emergency management topics, though a common theme was the importance of collaboration and education )] TJ ET 0.267 0.267 0.267 rg BT 498.267 536.603 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 507.904 535.095 Td /F1 9.8 Tf [( for improving )] TJ ET BT 26.250 523.191 Td /F1 9.8 Tf [(overall response to future disasters. One article articulated that part of effective planning and preparation is the inclusion of all )] TJ ET BT 26.250 511.286 Td /F1 9.8 Tf [(healthcare providers in disaster response, such as pharmacists )] TJ ET 0.267 0.267 0.267 rg BT 301.522 512.793 Td /F4 8.7 Tf [(34)] TJ ET 0.271 0.267 0.267 rg BT 311.159 511.286 Td /F1 9.8 Tf [(; another articulated the critical need for including clear )] TJ ET BT 26.250 499.381 Td /F1 9.8 Tf [(content related to disaster communication, providing guidance from national organizations, and following predetermined )] TJ ET BT 26.250 487.476 Td /F1 9.8 Tf [(communication plans )] TJ ET 0.267 0.267 0.267 rg BT 120.532 488.984 Td /F4 8.7 Tf [(35)] TJ ET 0.271 0.267 0.267 rg BT 130.170 487.476 Td /F1 9.8 Tf [(. Other articles provided specific examples of effective collaboration using Biosense )] TJ ET 0.267 0.267 0.267 rg BT 492.694 488.984 Td /F4 8.7 Tf [(31)] TJ ET BT 502.332 488.984 Td /F4 8.7 Tf [(33)] TJ ET BT 511.969 488.984 Td /F4 8.7 Tf [(36)] TJ ET 0.271 0.267 0.267 rg BT 521.606 487.476 Td /F1 9.8 Tf [(, a paradigm )] TJ ET BT 26.250 475.572 Td /F1 9.8 Tf [(for public health surveillance that collects and analyzes secondary data for bio-surveillance purposes, and can be used to )] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(effectively connect the VA with other agencies. Lastly, innovative approaches to track data predictive of disease outbreaks were )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(discussed )] TJ ET 0.267 0.267 0.267 rg BT 72.309 453.269 Td /F4 8.7 Tf [(37)] TJ ET BT 81.946 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 91.584 451.762 Td /F1 9.8 Tf [(, including a VA national electronic biosurveillance system to track cases of influenza )] TJ ET 0.267 0.267 0.267 rg BT 459.529 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 469.167 451.762 Td /F1 9.8 Tf [( and usage of VA )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(employee sick-days )] TJ ET 0.267 0.267 0.267 rg BT 114.566 441.365 Td /F4 8.7 Tf [(37)] TJ ET 0.271 0.267 0.267 rg BT 124.203 439.857 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(Additionally, three articles highlight the importance of VA to ensure its internal effectiveness related to disaster to be able to )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(continue providing emergency assistance to the wider community )] TJ ET 0.267 0.267 0.267 rg BT 310.736 410.055 Td /F4 8.7 Tf [(39)] TJ ET BT 320.373 410.055 Td /F4 8.7 Tf [(40)] TJ ET BT 330.010 410.055 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 339.648 408.548 Td /F1 9.8 Tf [(. For example, it is important that during mass-casualty )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(decontamination programs, VA continues primarily to protect itself so that it can maintain continuity of health care to veterans )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(and to respond to civilian needs )] TJ ET 0.267 0.267 0.267 rg BT 166.075 386.246 Td /F4 8.7 Tf [(39)] TJ ET 0.271 0.267 0.267 rg BT 175.712 384.738 Td /F1 9.8 Tf [(. Another means by which VA can effectively protect veterans is to design educational )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(campaigns about disaster planning that meet the specific needs of veterans and their families )] TJ ET 0.267 0.267 0.267 rg BT 431.070 374.341 Td /F4 8.7 Tf [(40)] TJ ET 0.271 0.267 0.267 rg BT 440.707 372.834 Td /F1 9.8 Tf [(. Lastly, recommendations for )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(an increase in risk evaluation and training regarding the security of radioactive material at VA facilities were presented )] TJ ET 0.267 0.267 0.267 rg BT 536.711 362.436 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 546.349 360.929 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(Overall, these articles indicate the importance of maintaining a strong VA system, which can then foster strong ties with other )] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(agencies and communities )] TJ ET 0.267 0.267 0.267 rg BT 144.381 338.627 Td /F4 8.7 Tf [(42)] TJ ET 0.271 0.267 0.267 rg BT 154.018 337.119 Td /F1 9.8 Tf [(, thus allowing for opportunities to share successful planning practices for decreasing disaster-)] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(related risk.)] TJ ET BT 26.250 288.612 Td /F4 12.0 Tf [(CONCLUSION)] TJ ET BT 26.250 268.658 Td /F1 9.8 Tf [(This literature review identified and synthesized 41 peer-reviewed articles about VA-related emergency management. The )] TJ ET BT 26.250 256.753 Td /F1 9.8 Tf [(majority of articles were pre-experimental. While this affords us with detailed case studies about specific disasters, more )] TJ ET BT 26.250 244.848 Td /F1 9.8 Tf [(experimental research would be beneficial. For example, evidence-based prevention programs for PTSD and other mental )] TJ ET BT 26.250 232.944 Td /F1 9.8 Tf [(health issues following disaster could greatly add to the stress and coping literature on veterans and serve as the foundation for )] TJ ET BT 26.250 221.039 Td /F1 9.8 Tf [(the development of effective intervention. Similarly, few studies used mixed method design. More studies on emergency )] TJ ET BT 26.250 209.134 Td /F1 9.8 Tf [(management that integrates qualitative and quantitative data will afford the field with a more coherent and complete picture of its )] TJ ET BT 26.250 197.229 Td /F1 9.8 Tf [(strengths and gaps. Additionally, among the phases of emergency management, there is need for more work particularly on )] TJ ET BT 26.250 185.325 Td /F1 9.8 Tf [(preparedness. While twelve articles mentioned some aspect of preparedness, only two articles specifically addressed plans to )] TJ ET BT 26.250 173.420 Td /F1 9.8 Tf [(handle an emergency, calling for an increased need of effective communication practices. We suggest more studies on the )] TJ ET BT 26.250 161.515 Td /F1 9.8 Tf [(processes necessary for effective community collaboration and development of plans and protocols to prepare for possible )] TJ ET BT 26.250 149.610 Td /F1 9.8 Tf [(emergencies.)] TJ ET BT 26.250 130.206 Td /F1 9.8 Tf [(Overall, five themes emerged from this review. The first is the effects of disaster on mental health status and services use. This )] TJ ET BT 26.250 118.301 Td /F1 9.8 Tf [(group of articles point to a need for ongoing longitudinal studies on mental health impact due to disaster, as well as increased )] TJ ET BT 26.250 106.396 Td /F1 9.8 Tf [(outreach efforts to victims. Also, only a few studies examined individual differences in mental health impact \(e.g., ethnicity\). This )] TJ ET BT 26.250 94.491 Td /F1 9.8 Tf [(gap could be remedied with increased research efforts related to psychosocial risk factors and individuals vulnerability to )] TJ ET BT 26.250 82.587 Td /F1 9.8 Tf [(disaster. We suggest including ethnicity, SES, gender, and age as key variables in future research.)] TJ ET BT 26.250 63.182 Td /F1 9.8 Tf [(The second theme, effects of disaster on general health services use, highlighted the need for continuity of care. Several )] TJ ET BT 26.250 51.277 Td /F1 9.8 Tf [(barriers were identified including poor communication infrastructure, although effective collaboration, such as with pharmacists, )] TJ ET BT 26.250 39.372 Td /F1 9.8 Tf [(was shown to mitigate such challenges. Hospital administrators and public health officials would greatly benefit from an )] TJ ET Q q 15.000 25.087 577.500 751.913 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(continuity of care in these and other disasters included pain management )] TJ ET 0.267 0.267 0.267 rg BT 344.909 768.983 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 354.547 767.476 Td /F1 9.8 Tf [( and providing care despite adverse weather )] TJ ET 0.267 0.267 0.267 rg BT 549.098 768.983 Td /F4 8.7 Tf [(26)] TJ ET BT 558.735 768.983 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 26.250 755.571 Td /F1 9.8 Tf [(and loss of water and power )] TJ ET 0.267 0.267 0.267 rg BT 150.894 757.079 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 160.531 755.571 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(All of the studies detailed lessons learned and modifications in disaster planning that have been made since the disaster. These )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(include increased training, stocking indoor supplies, and the development of mitigation teams that supervise improvements in )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(disaster preparedness )] TJ ET 0.267 0.267 0.267 rg BT 125.417 713.864 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 135.055 712.357 Td /F1 9.8 Tf [(. The development of plans should take into account the need for prolonged recovery above and )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(beyond the acute disaster event )] TJ ET 0.267 0.267 0.267 rg BT 167.167 701.960 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 176.804 700.452 Td /F1 9.8 Tf [(, though plans should be flexible enough to allow for creative, on-the-spot problem solving [)] TJ ET 0.267 0.267 0.267 rg BT 26.250 690.055 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 35.887 688.548 Td /F1 9.8 Tf [(, p.156].)] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(A disaster response framework )] TJ ET 0.267 0.267 0.267 rg BT 163.335 670.650 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 172.972 669.143 Td /F1 9.8 Tf [( makes salient the need to provide comprehensive care during evacuation, especially for )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(vulnerable nursing home residents. The proposed framework was designed to address the comprehensive needs of patients )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(during evacuation, including the role of the community, as well as highlight the significance of communication and collaboration )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(with federal, state, and local emergency entities. Similar to the above articles, it addresses the role of the community and )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(coordination of services necessary for successful short-term and long-term evacuation-related outcomes that moved above and )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(beyond temporary evacuation to consider the need for permanent evacuations, especially for vulnerable nursing home )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(residents. Overall, all of the articles point to the need for continued evidence-based studies on evacuation preparedness and )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(response.)] TJ ET BT 26.250 566.405 Td /F4 9.8 Tf [(Disaster Planning/Preparedness)] TJ ET BT 26.250 547.000 Td /F1 9.8 Tf [(Twelve of the included articles are about disaster planning and preparedness. These articles covered a wide variety of )] TJ ET BT 26.250 535.095 Td /F1 9.8 Tf [(emergency management topics, though a common theme was the importance of collaboration and education )] TJ ET 0.267 0.267 0.267 rg BT 498.267 536.603 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 507.904 535.095 Td /F1 9.8 Tf [( for improving )] TJ ET BT 26.250 523.191 Td /F1 9.8 Tf [(overall response to future disasters. One article articulated that part of effective planning and preparation is the inclusion of all )] TJ ET BT 26.250 511.286 Td /F1 9.8 Tf [(healthcare providers in disaster response, such as pharmacists )] TJ ET 0.267 0.267 0.267 rg BT 301.522 512.793 Td /F4 8.7 Tf [(34)] TJ ET 0.271 0.267 0.267 rg BT 311.159 511.286 Td /F1 9.8 Tf [(; another articulated the critical need for including clear )] TJ ET BT 26.250 499.381 Td /F1 9.8 Tf [(content related to disaster communication, providing guidance from national organizations, and following predetermined )] TJ ET BT 26.250 487.476 Td /F1 9.8 Tf [(communication plans )] TJ ET 0.267 0.267 0.267 rg BT 120.532 488.984 Td /F4 8.7 Tf [(35)] TJ ET 0.271 0.267 0.267 rg BT 130.170 487.476 Td /F1 9.8 Tf [(. Other articles provided specific examples of effective collaboration using Biosense )] TJ ET 0.267 0.267 0.267 rg BT 492.694 488.984 Td /F4 8.7 Tf [(31)] TJ ET BT 502.332 488.984 Td /F4 8.7 Tf [(33)] TJ ET BT 511.969 488.984 Td /F4 8.7 Tf [(36)] TJ ET 0.271 0.267 0.267 rg BT 521.606 487.476 Td /F1 9.8 Tf [(, a paradigm )] TJ ET BT 26.250 475.572 Td /F1 9.8 Tf [(for public health surveillance that collects and analyzes secondary data for bio-surveillance purposes, and can be used to )] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(effectively connect the VA with other agencies. Lastly, innovative approaches to track data predictive of disease outbreaks were )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(discussed )] TJ ET 0.267 0.267 0.267 rg BT 72.309 453.269 Td /F4 8.7 Tf [(37)] TJ ET BT 81.946 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 91.584 451.762 Td /F1 9.8 Tf [(, including a VA national electronic biosurveillance system to track cases of influenza )] TJ ET 0.267 0.267 0.267 rg BT 459.529 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 469.167 451.762 Td /F1 9.8 Tf [( and usage of VA )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(employee sick-days )] TJ ET 0.267 0.267 0.267 rg BT 114.566 441.365 Td /F4 8.7 Tf [(37)] TJ ET 0.271 0.267 0.267 rg BT 124.203 439.857 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(Additionally, three articles highlight the importance of VA to ensure its internal effectiveness related to disaster to be able to )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(continue providing emergency assistance to the wider community )] TJ ET 0.267 0.267 0.267 rg BT 310.736 410.055 Td /F4 8.7 Tf [(39)] TJ ET BT 320.373 410.055 Td /F4 8.7 Tf [(40)] TJ ET BT 330.010 410.055 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 339.648 408.548 Td /F1 9.8 Tf [(. For example, it is important that during mass-casualty )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(decontamination programs, VA continues primarily to protect itself so that it can maintain continuity of health care to veterans )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(and to respond to civilian needs )] TJ ET 0.267 0.267 0.267 rg BT 166.075 386.246 Td /F4 8.7 Tf [(39)] TJ ET 0.271 0.267 0.267 rg BT 175.712 384.738 Td /F1 9.8 Tf [(. Another means by which VA can effectively protect veterans is to design educational )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(campaigns about disaster planning that meet the specific needs of veterans and their families )] TJ ET 0.267 0.267 0.267 rg BT 431.070 374.341 Td /F4 8.7 Tf [(40)] TJ ET 0.271 0.267 0.267 rg BT 440.707 372.834 Td /F1 9.8 Tf [(. Lastly, recommendations for )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(an increase in risk evaluation and training regarding the security of radioactive material at VA facilities were presented )] TJ ET 0.267 0.267 0.267 rg BT 536.711 362.436 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 546.349 360.929 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(Overall, these articles indicate the importance of maintaining a strong VA system, which can then foster strong ties with other )] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(agencies and communities )] TJ ET 0.267 0.267 0.267 rg BT 144.381 338.627 Td /F4 8.7 Tf [(42)] TJ ET 0.271 0.267 0.267 rg BT 154.018 337.119 Td /F1 9.8 Tf [(, thus allowing for opportunities to share successful planning practices for decreasing disaster-)] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(related risk.)] TJ ET BT 26.250 288.612 Td /F4 12.0 Tf [(CONCLUSION)] TJ ET BT 26.250 268.658 Td /F1 9.8 Tf [(This literature review identified and synthesized 41 peer-reviewed articles about VA-related emergency management. The )] TJ ET BT 26.250 256.753 Td /F1 9.8 Tf [(majority of articles were pre-experimental. While this affords us with detailed case studies about specific disasters, more )] TJ ET BT 26.250 244.848 Td /F1 9.8 Tf [(experimental research would be beneficial. For example, evidence-based prevention programs for PTSD and other mental )] TJ ET BT 26.250 232.944 Td /F1 9.8 Tf [(health issues following disaster could greatly add to the stress and coping literature on veterans and serve as the foundation for )] TJ ET BT 26.250 221.039 Td /F1 9.8 Tf [(the development of effective intervention. Similarly, few studies used mixed method design. More studies on emergency )] TJ ET BT 26.250 209.134 Td /F1 9.8 Tf [(management that integrates qualitative and quantitative data will afford the field with a more coherent and complete picture of its )] TJ ET BT 26.250 197.229 Td /F1 9.8 Tf [(strengths and gaps. Additionally, among the phases of emergency management, there is need for more work particularly on )] TJ ET BT 26.250 185.325 Td /F1 9.8 Tf [(preparedness. While twelve articles mentioned some aspect of preparedness, only two articles specifically addressed plans to )] TJ ET BT 26.250 173.420 Td /F1 9.8 Tf [(handle an emergency, calling for an increased need of effective communication practices. We suggest more studies on the )] TJ ET BT 26.250 161.515 Td /F1 9.8 Tf [(processes necessary for effective community collaboration and development of plans and protocols to prepare for possible )] TJ ET BT 26.250 149.610 Td /F1 9.8 Tf [(emergencies.)] TJ ET BT 26.250 130.206 Td /F1 9.8 Tf [(Overall, five themes emerged from this review. The first is the effects of disaster on mental health status and services use. This )] TJ ET BT 26.250 118.301 Td /F1 9.8 Tf [(group of articles point to a need for ongoing longitudinal studies on mental health impact due to disaster, as well as increased )] TJ ET BT 26.250 106.396 Td /F1 9.8 Tf [(outreach efforts to victims. Also, only a few studies examined individual differences in mental health impact \(e.g., ethnicity\). This )] TJ ET BT 26.250 94.491 Td /F1 9.8 Tf [(gap could be remedied with increased research efforts related to psychosocial risk factors and individuals vulnerability to )] TJ ET BT 26.250 82.587 Td /F1 9.8 Tf [(disaster. We suggest including ethnicity, SES, gender, and age as key variables in future research.)] TJ ET BT 26.250 63.182 Td /F1 9.8 Tf [(The second theme, effects of disaster on general health services use, highlighted the need for continuity of care. Several )] TJ ET BT 26.250 51.277 Td /F1 9.8 Tf [(barriers were identified including poor communication infrastructure, although effective collaboration, such as with pharmacists, )] TJ ET BT 26.250 39.372 Td /F1 9.8 Tf [(was shown to mitigate such challenges. Hospital administrators and public health officials would greatly benefit from an )] TJ ET Q q 15.000 25.087 577.500 751.913 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(continuity of care in these and other disasters included pain management )] TJ ET 0.267 0.267 0.267 rg BT 344.909 768.983 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 354.547 767.476 Td /F1 9.8 Tf [( and providing care despite adverse weather )] TJ ET 0.267 0.267 0.267 rg BT 549.098 768.983 Td /F4 8.7 Tf [(26)] TJ ET BT 558.735 768.983 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 26.250 755.571 Td /F1 9.8 Tf [(and loss of water and power )] TJ ET 0.267 0.267 0.267 rg BT 150.894 757.079 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 160.531 755.571 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(All of the studies detailed lessons learned and modifications in disaster planning that have been made since the disaster. These )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(include increased training, stocking indoor supplies, and the development of mitigation teams that supervise improvements in )] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(disaster preparedness )] TJ ET 0.267 0.267 0.267 rg BT 125.417 713.864 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 135.055 712.357 Td /F1 9.8 Tf [(. The development of plans should take into account the need for prolonged recovery above and )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(beyond the acute disaster event )] TJ ET 0.267 0.267 0.267 rg BT 167.167 701.960 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 176.804 700.452 Td /F1 9.8 Tf [(, though plans should be flexible enough to allow for creative, on-the-spot problem solving [)] TJ ET 0.267 0.267 0.267 rg BT 26.250 690.055 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 35.887 688.548 Td /F1 9.8 Tf [(, p.156].)] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(A disaster response framework )] TJ ET 0.267 0.267 0.267 rg BT 163.335 670.650 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 172.972 669.143 Td /F1 9.8 Tf [( makes salient the need to provide comprehensive care during evacuation, especially for )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(vulnerable nursing home residents. The proposed framework was designed to address the comprehensive needs of patients )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(during evacuation, including the role of the community, as well as highlight the significance of communication and collaboration )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(with federal, state, and local emergency entities. Similar to the above articles, it addresses the role of the community and )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(coordination of services necessary for successful short-term and long-term evacuation-related outcomes that moved above and )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(beyond temporary evacuation to consider the need for permanent evacuations, especially for vulnerable nursing home )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(residents. Overall, all of the articles point to the need for continued evidence-based studies on evacuation preparedness and )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(response.)] TJ ET BT 26.250 566.405 Td /F4 9.8 Tf [(Disaster Planning/Preparedness)] TJ ET BT 26.250 547.000 Td /F1 9.8 Tf [(Twelve of the included articles are about disaster planning and preparedness. These articles covered a wide variety of )] TJ ET BT 26.250 535.095 Td /F1 9.8 Tf [(emergency management topics, though a common theme was the importance of collaboration and education )] TJ ET 0.267 0.267 0.267 rg BT 498.267 536.603 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 507.904 535.095 Td /F1 9.8 Tf [( for improving )] TJ ET BT 26.250 523.191 Td /F1 9.8 Tf [(overall response to future disasters. One article articulated that part of effective planning and preparation is the inclusion of all )] TJ ET BT 26.250 511.286 Td /F1 9.8 Tf [(healthcare providers in disaster response, such as pharmacists )] TJ ET 0.267 0.267 0.267 rg BT 301.522 512.793 Td /F4 8.7 Tf [(34)] TJ ET 0.271 0.267 0.267 rg BT 311.159 511.286 Td /F1 9.8 Tf [(; another articulated the critical need for including clear )] TJ ET BT 26.250 499.381 Td /F1 9.8 Tf [(content related to disaster communication, providing guidance from national organizations, and following predetermined )] TJ ET BT 26.250 487.476 Td /F1 9.8 Tf [(communication plans )] TJ ET 0.267 0.267 0.267 rg BT 120.532 488.984 Td /F4 8.7 Tf [(35)] TJ ET 0.271 0.267 0.267 rg BT 130.170 487.476 Td /F1 9.8 Tf [(. Other articles provided specific examples of effective collaboration using Biosense )] TJ ET 0.267 0.267 0.267 rg BT 492.694 488.984 Td /F4 8.7 Tf [(31)] TJ ET BT 502.332 488.984 Td /F4 8.7 Tf [(33)] TJ ET BT 511.969 488.984 Td /F4 8.7 Tf [(36)] TJ ET 0.271 0.267 0.267 rg BT 521.606 487.476 Td /F1 9.8 Tf [(, a paradigm )] TJ ET BT 26.250 475.572 Td /F1 9.8 Tf [(for public health surveillance that collects and analyzes secondary data for bio-surveillance purposes, and can be used to )] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(effectively connect the VA with other agencies. Lastly, innovative approaches to track data predictive of disease outbreaks were )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(discussed )] TJ ET 0.267 0.267 0.267 rg BT 72.309 453.269 Td /F4 8.7 Tf [(37)] TJ ET BT 81.946 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 91.584 451.762 Td /F1 9.8 Tf [(, including a VA national electronic biosurveillance system to track cases of influenza )] TJ ET 0.267 0.267 0.267 rg BT 459.529 453.269 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 469.167 451.762 Td /F1 9.8 Tf [( and usage of VA )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(employee sick-days )] TJ ET 0.267 0.267 0.267 rg BT 114.566 441.365 Td /F4 8.7 Tf [(37)] TJ ET 0.271 0.267 0.267 rg BT 124.203 439.857 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 420.453 Td /F1 9.8 Tf [(Additionally, three articles highlight the importance of VA to ensure its internal effectiveness related to disaster to be able to )] TJ ET BT 26.250 408.548 Td /F1 9.8 Tf [(continue providing emergency assistance to the wider community )] TJ ET 0.267 0.267 0.267 rg BT 310.736 410.055 Td /F4 8.7 Tf [(39)] TJ ET BT 320.373 410.055 Td /F4 8.7 Tf [(40)] TJ ET BT 330.010 410.055 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 339.648 408.548 Td /F1 9.8 Tf [(. For example, it is important that during mass-casualty )] TJ ET BT 26.250 396.643 Td /F1 9.8 Tf [(decontamination programs, VA continues primarily to protect itself so that it can maintain continuity of health care to veterans )] TJ ET BT 26.250 384.738 Td /F1 9.8 Tf [(and to respond to civilian needs )] TJ ET 0.267 0.267 0.267 rg BT 166.075 386.246 Td /F4 8.7 Tf [(39)] TJ ET 0.271 0.267 0.267 rg BT 175.712 384.738 Td /F1 9.8 Tf [(. Another means by which VA can effectively protect veterans is to design educational )] TJ ET BT 26.250 372.834 Td /F1 9.8 Tf [(campaigns about disaster planning that meet the specific needs of veterans and their families )] TJ ET 0.267 0.267 0.267 rg BT 431.070 374.341 Td /F4 8.7 Tf [(40)] TJ ET 0.271 0.267 0.267 rg BT 440.707 372.834 Td /F1 9.8 Tf [(. Lastly, recommendations for )] TJ ET BT 26.250 360.929 Td /F1 9.8 Tf [(an increase in risk evaluation and training regarding the security of radioactive material at VA facilities were presented )] TJ ET 0.267 0.267 0.267 rg BT 536.711 362.436 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 546.349 360.929 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 349.024 Td /F1 9.8 Tf [(Overall, these articles indicate the importance of maintaining a strong VA system, which can then foster strong ties with other )] TJ ET BT 26.250 337.119 Td /F1 9.8 Tf [(agencies and communities )] TJ ET 0.267 0.267 0.267 rg BT 144.381 338.627 Td /F4 8.7 Tf [(42)] TJ ET 0.271 0.267 0.267 rg BT 154.018 337.119 Td /F1 9.8 Tf [(, thus allowing for opportunities to share successful planning practices for decreasing disaster-)] TJ ET BT 26.250 325.215 Td /F1 9.8 Tf [(related risk.)] TJ ET BT 26.250 288.612 Td /F4 12.0 Tf [(CONCLUSION)] TJ ET BT 26.250 268.658 Td /F1 9.8 Tf [(This literature review identified and synthesized 41 peer-reviewed articles about VA-related emergency management. The )] TJ ET BT 26.250 256.753 Td /F1 9.8 Tf [(majority of articles were pre-experimental. While this affords us with detailed case studies about specific disasters, more )] TJ ET BT 26.250 244.848 Td /F1 9.8 Tf [(experimental research would be beneficial. For example, evidence-based prevention programs for PTSD and other mental )] TJ ET BT 26.250 232.944 Td /F1 9.8 Tf [(health issues following disaster could greatly add to the stress and coping literature on veterans and serve as the foundation for )] TJ ET BT 26.250 221.039 Td /F1 9.8 Tf [(the development of effective intervention. Similarly, few studies used mixed method design. More studies on emergency )] TJ ET BT 26.250 209.134 Td /F1 9.8 Tf [(management that integrates qualitative and quantitative data will afford the field with a more coherent and complete picture of its )] TJ ET BT 26.250 197.229 Td /F1 9.8 Tf [(strengths and gaps. Additionally, among the phases of emergency management, there is need for more work particularly on )] TJ ET BT 26.250 185.325 Td /F1 9.8 Tf [(preparedness. While twelve articles mentioned some aspect of preparedness, only two articles specifically addressed plans to )] TJ ET BT 26.250 173.420 Td /F1 9.8 Tf [(handle an emergency, calling for an increased need of effective communication practices. We suggest more studies on the )] TJ ET BT 26.250 161.515 Td /F1 9.8 Tf [(processes necessary for effective community collaboration and development of plans and protocols to prepare for possible )] TJ ET BT 26.250 149.610 Td /F1 9.8 Tf [(emergencies.)] TJ ET BT 26.250 130.206 Td /F1 9.8 Tf [(Overall, five themes emerged from this review. The first is the effects of disaster on mental health status and services use. This )] TJ ET BT 26.250 118.301 Td /F1 9.8 Tf [(group of articles point to a need for ongoing longitudinal studies on mental health impact due to disaster, as well as increased )] TJ ET BT 26.250 106.396 Td /F1 9.8 Tf [(outreach efforts to victims. Also, only a few studies examined individual differences in mental health impact \(e.g., ethnicity\). This )] TJ ET BT 26.250 94.491 Td /F1 9.8 Tf [(gap could be remedied with increased research efforts related to psychosocial risk factors and individuals vulnerability to )] TJ ET BT 26.250 82.587 Td /F1 9.8 Tf [(disaster. We suggest including ethnicity, SES, gender, and age as key variables in future research.)] TJ ET BT 26.250 63.182 Td /F1 9.8 Tf [(The second theme, effects of disaster on general health services use, highlighted the need for continuity of care. Several )] TJ ET BT 26.250 51.277 Td /F1 9.8 Tf [(barriers were identified including poor communication infrastructure, although effective collaboration, such as with pharmacists, )] TJ ET BT 26.250 39.372 Td /F1 9.8 Tf [(was shown to mitigate such challenges. Hospital administrators and public health officials would greatly benefit from an )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(5)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 373 0 obj << /Type /Annot /Subtype /Link /A 374 0 R /Border [0 0 0] /H /I /Rect [ 344.9092 768.1817 354.5466 777.0000 ] >> endobj 374 0 obj << /Type /Action >> endobj 375 0 obj << /Type /Annot /Subtype /Link /A 376 0 R /Border [0 0 0] /H /I /Rect [ 549.0981 768.1817 558.7354 777.0000 ] >> endobj 376 0 obj << /Type /Action >> endobj 377 0 obj << /Type /Annot /Subtype /Link /A 378 0 R /Border [0 0 0] /H /I /Rect [ 558.7354 768.1817 568.3727 777.0000 ] >> endobj 378 0 obj << /Type /Action >> endobj 379 0 obj << /Type /Annot /Subtype /Link /A 380 0 R /Border [0 0 0] /H /I /Rect [ 150.8940 756.2769 160.5313 765.0952 ] >> endobj 380 0 obj << /Type /Action >> endobj 381 0 obj << /Type /Annot /Subtype /Link /A 382 0 R /Border [0 0 0] /H /I /Rect [ 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15.000 44.674 577.500 732.326 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(inclusive approach to communication practices. Related articles documented patients preference for receiving treatment in their )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(community, such as through mobile clinics. This makes salient the need for support and camaraderie in disaster recovery. The )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(need for ongoing discussion about planning for both short-term and long-term health care services was highlighted, as was )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(greater understanding of the specific needs of the community being served.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(The third theme, patient tracking, sheds light on the need for systematic protocols to organize data on patients receiving care )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(following a disaster. Examples of successful processes were shared. These articles serve as a necessary reminder of the )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(critical need of tracking for patient survival following disaster.)] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(The fourth theme, evacuation, indicates an overall need for more evidence-based research, including decision-making and the )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(roles of all personnel during disaster, including plans for ongoing collaboration and communication with city officials and local )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(hospitals, especially as it relates to back-up evacuation plans. Efforts to develop plans for long-term evacuation were also )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(deemed as critical. Careful consideration also needs to be given to identifying best practices for evacuation practices for )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(specific, unique populations being served. Community needs assessments prior to and following disaster are thus )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(recommended.)] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(Articles related to disaster planning/preparation shed light on the importance of collaboration. This is particularly necessary as it )] TJ ET BT 26.250 578.310 Td /F1 9.8 Tf [(relates to interrelationships between the VHA and community partners during local emergencies and federal disasters. This is )] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(also critical as it pertains to ongoing dissemination of research findings related to disaster experiences. With increased )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(collaboration and communication, overall disaster planning and response mechanisms can be strengthened. Interestingly,this )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(call for action reflects the mission of the Evidence Aid project )] TJ ET 0.267 0.267 0.267 rg BT 291.236 544.103 Td /F4 8.7 Tf [(43)] TJ ET BT 300.873 544.103 Td /F4 8.7 Tf [(44)] TJ ET 0.271 0.267 0.267 rg BT 310.510 542.595 Td /F1 9.8 Tf [( which grew out of The Cochrane Collaboration, an )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(international network linking together healthcare providers, policy makers, patients and their advocates worldwide in an effort to )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(improve health-care decisions. This is achieved in part through The Cochrane Library, which houses on-line databases of )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(literature and research, including randomized controlled trial studies and systematic reviews, on health care practices. Through )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(dissemination of high-quality research on disaster health problems, we can support interested parties to timely and cutting-edge )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(information on best practices that will likely improve the quality of life of those affected by disaster.)] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(Finally, while additional research is needed within each theme identified, it is also important to note that these themes are not )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(mutually exclusive; rather they influence each other. For example, increased tracking of services following disaster directly )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(informs decision-making regarding service provision. Similarly, continuity of care is not merely a challenge within general health )] TJ ET BT 26.250 427.953 Td /F1 9.8 Tf [(services usage, but should also be a topic of discussion within all phases of emergency management for both general and )] TJ ET BT 26.250 416.048 Td /F1 9.8 Tf [(mental health services usage. An integrated, comprehensive approach to research will provide a clearer picture about the role )] TJ ET BT 26.250 404.143 Td /F1 9.8 Tf [(of VA in caring for veterans during times of disaster and also about VA as a collaborator that provides support to the community )] TJ ET BT 26.250 392.238 Td /F1 9.8 Tf [(before, during and after a disaster.)] TJ ET BT 26.250 355.636 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 335.682 Td /F1 9.8 Tf [(The authors declare the no competing interests exist)] TJ ET BT 26.250 299.079 Td /F4 12.0 Tf [(Correspondence)] TJ ET BT 26.250 279.125 Td /F1 9.8 Tf [(Corresponding Author: Maria Claver \(mclaver@csulb.edu\))] TJ ET BT 26.250 242.522 Td /F4 12.0 Tf [(APPENDIX 1)] TJ ET BT 26.250 205.370 Td /F4 12.0 Tf [(Articles included in the systematic literature review)] TJ ET 0.267 0.267 0.267 rg BT 26.250 185.416 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 185.416 Td /F1 9.8 Tf [( \(50KB\))] TJ ET BT 26.250 148.814 Td /F4 12.0 Tf [(APPENDIX 2)] TJ ET BT 26.250 111.662 Td /F4 12.0 Tf [(PRISMA Checklist)] TJ ET 0.267 0.267 0.267 rg BT 26.250 91.707 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 91.707 Td /F1 9.8 Tf [( \(85KB\))] TJ ET BT 26.250 55.105 Td /F4 12.0 Tf [(References)] TJ ET Q q 15.000 44.674 577.500 732.326 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(inclusive approach to communication practices. Related articles documented patients preference for receiving treatment in their )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(community, such as through mobile clinics. This makes salient the need for support and camaraderie in disaster recovery. The )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(need for ongoing discussion about planning for both short-term and long-term health care services was highlighted, as was )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(greater understanding of the specific needs of the community being served.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(The third theme, patient tracking, sheds light on the need for systematic protocols to organize data on patients receiving care )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(following a disaster. Examples of successful processes were shared. These articles serve as a necessary reminder of the )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(critical need of tracking for patient survival following disaster.)] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(The fourth theme, evacuation, indicates an overall need for more evidence-based research, including decision-making and the )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(roles of all personnel during disaster, including plans for ongoing collaboration and communication with city officials and local )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(hospitals, especially as it relates to back-up evacuation plans. Efforts to develop plans for long-term evacuation were also )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(deemed as critical. Careful consideration also needs to be given to identifying best practices for evacuation practices for )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(specific, unique populations being served. Community needs assessments prior to and following disaster are thus )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(recommended.)] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(Articles related to disaster planning/preparation shed light on the importance of collaboration. This is particularly necessary as it )] TJ ET BT 26.250 578.310 Td /F1 9.8 Tf [(relates to interrelationships between the VHA and community partners during local emergencies and federal disasters. This is )] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(also critical as it pertains to ongoing dissemination of research findings related to disaster experiences. With increased )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(collaboration and communication, overall disaster planning and response mechanisms can be strengthened. Interestingly,this )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(call for action reflects the mission of the Evidence Aid project )] TJ ET 0.267 0.267 0.267 rg BT 291.236 544.103 Td /F4 8.7 Tf [(43)] TJ ET BT 300.873 544.103 Td /F4 8.7 Tf [(44)] TJ ET 0.271 0.267 0.267 rg BT 310.510 542.595 Td /F1 9.8 Tf [( which grew out of The Cochrane Collaboration, an )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(international network linking together healthcare providers, policy makers, patients and their advocates worldwide in an effort to )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(improve health-care decisions. This is achieved in part through The Cochrane Library, which houses on-line databases of )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(literature and research, including randomized controlled trial studies and systematic reviews, on health care practices. Through )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(dissemination of high-quality research on disaster health problems, we can support interested parties to timely and cutting-edge )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(information on best practices that will likely improve the quality of life of those affected by disaster.)] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(Finally, while additional research is needed within each theme identified, it is also important to note that these themes are not )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(mutually exclusive; rather they influence each other. For example, increased tracking of services following disaster directly )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(informs decision-making regarding service provision. Similarly, continuity of care is not merely a challenge within general health )] TJ ET BT 26.250 427.953 Td /F1 9.8 Tf [(services usage, but should also be a topic of discussion within all phases of emergency management for both general and )] TJ ET BT 26.250 416.048 Td /F1 9.8 Tf [(mental health services usage. An integrated, comprehensive approach to research will provide a clearer picture about the role )] TJ ET BT 26.250 404.143 Td /F1 9.8 Tf [(of VA in caring for veterans during times of disaster and also about VA as a collaborator that provides support to the community )] TJ ET BT 26.250 392.238 Td /F1 9.8 Tf [(before, during and after a disaster.)] TJ ET BT 26.250 355.636 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 335.682 Td /F1 9.8 Tf [(The authors declare the no competing interests exist)] TJ ET BT 26.250 299.079 Td /F4 12.0 Tf [(Correspondence)] TJ ET BT 26.250 279.125 Td /F1 9.8 Tf [(Corresponding Author: Maria Claver \(mclaver@csulb.edu\))] TJ ET BT 26.250 242.522 Td /F4 12.0 Tf [(APPENDIX 1)] TJ ET BT 26.250 205.370 Td /F4 12.0 Tf [(Articles included in the systematic literature review)] TJ ET 0.267 0.267 0.267 rg BT 26.250 185.416 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 185.416 Td /F1 9.8 Tf [( \(50KB\))] TJ ET BT 26.250 148.814 Td /F4 12.0 Tf [(APPENDIX 2)] TJ ET BT 26.250 111.662 Td /F4 12.0 Tf [(PRISMA Checklist)] TJ ET 0.267 0.267 0.267 rg BT 26.250 91.707 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 91.707 Td /F1 9.8 Tf [( \(85KB\))] TJ ET BT 26.250 55.105 Td /F4 12.0 Tf [(References)] TJ ET Q q 15.000 44.674 577.500 732.326 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(inclusive approach to communication practices. Related articles documented patients preference for receiving treatment in their )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(community, such as through mobile clinics. This makes salient the need for support and camaraderie in disaster recovery. The )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(need for ongoing discussion about planning for both short-term and long-term health care services was highlighted, as was )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(greater understanding of the specific needs of the community being served.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(The third theme, patient tracking, sheds light on the need for systematic protocols to organize data on patients receiving care )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(following a disaster. Examples of successful processes were shared. These articles serve as a necessary reminder of the )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(critical need of tracking for patient survival following disaster.)] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(The fourth theme, evacuation, indicates an overall need for more evidence-based research, including decision-making and the )] TJ ET BT 26.250 657.238 Td /F1 9.8 Tf [(roles of all personnel during disaster, including plans for ongoing collaboration and communication with city officials and local )] TJ ET BT 26.250 645.333 Td /F1 9.8 Tf [(hospitals, especially as it relates to back-up evacuation plans. Efforts to develop plans for long-term evacuation were also )] TJ ET BT 26.250 633.429 Td /F1 9.8 Tf [(deemed as critical. Careful consideration also needs to be given to identifying best practices for evacuation practices for )] TJ ET BT 26.250 621.524 Td /F1 9.8 Tf [(specific, unique populations being served. Community needs assessments prior to and following disaster are thus )] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(recommended.)] TJ ET BT 26.250 590.214 Td /F1 9.8 Tf [(Articles related to disaster planning/preparation shed light on the importance of collaboration. This is particularly necessary as it )] TJ ET BT 26.250 578.310 Td /F1 9.8 Tf [(relates to interrelationships between the VHA and community partners during local emergencies and federal disasters. This is )] TJ ET BT 26.250 566.405 Td /F1 9.8 Tf [(also critical as it pertains to ongoing dissemination of research findings related to disaster experiences. With increased )] TJ ET BT 26.250 554.500 Td /F1 9.8 Tf [(collaboration and communication, overall disaster planning and response mechanisms can be strengthened. Interestingly,this )] TJ ET BT 26.250 542.595 Td /F1 9.8 Tf [(call for action reflects the mission of the Evidence Aid project )] TJ ET 0.267 0.267 0.267 rg BT 291.236 544.103 Td /F4 8.7 Tf [(43)] TJ ET BT 300.873 544.103 Td /F4 8.7 Tf [(44)] TJ ET 0.271 0.267 0.267 rg BT 310.510 542.595 Td /F1 9.8 Tf [( which grew out of The Cochrane Collaboration, an )] TJ ET BT 26.250 530.691 Td /F1 9.8 Tf [(international network linking together healthcare providers, policy makers, patients and their advocates worldwide in an effort to )] TJ ET BT 26.250 518.786 Td /F1 9.8 Tf [(improve health-care decisions. This is achieved in part through The Cochrane Library, which houses on-line databases of )] TJ ET BT 26.250 506.881 Td /F1 9.8 Tf [(literature and research, including randomized controlled trial studies and systematic reviews, on health care practices. Through )] TJ ET BT 26.250 494.976 Td /F1 9.8 Tf [(dissemination of high-quality research on disaster health problems, we can support interested parties to timely and cutting-edge )] TJ ET BT 26.250 483.072 Td /F1 9.8 Tf [(information on best practices that will likely improve the quality of life of those affected by disaster.)] TJ ET BT 26.250 463.667 Td /F1 9.8 Tf [(Finally, while additional research is needed within each theme identified, it is also important to note that these themes are not )] TJ ET BT 26.250 451.762 Td /F1 9.8 Tf [(mutually exclusive; rather they influence each other. For example, increased tracking of services following disaster directly )] TJ ET BT 26.250 439.857 Td /F1 9.8 Tf [(informs decision-making regarding service provision. Similarly, continuity of care is not merely a challenge within general health )] TJ ET BT 26.250 427.953 Td /F1 9.8 Tf [(services usage, but should also be a topic of discussion within all phases of emergency management for both general and )] TJ ET BT 26.250 416.048 Td /F1 9.8 Tf [(mental health services usage. An integrated, comprehensive approach to research will provide a clearer picture about the role )] TJ ET BT 26.250 404.143 Td /F1 9.8 Tf [(of VA in caring for veterans during times of disaster and also about VA as a collaborator that provides support to the community )] TJ ET BT 26.250 392.238 Td /F1 9.8 Tf [(before, during and after a disaster.)] TJ ET BT 26.250 355.636 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 335.682 Td /F1 9.8 Tf [(The authors declare the no competing interests exist)] TJ ET BT 26.250 299.079 Td /F4 12.0 Tf [(Correspondence)] TJ ET BT 26.250 279.125 Td /F1 9.8 Tf [(Corresponding Author: Maria Claver \(mclaver@csulb.edu\))] TJ ET BT 26.250 242.522 Td /F4 12.0 Tf [(APPENDIX 1)] TJ ET BT 26.250 205.370 Td /F4 12.0 Tf [(Articles included in the systematic literature review)] TJ ET 0.267 0.267 0.267 rg BT 26.250 185.416 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 185.416 Td /F1 9.8 Tf [( \(50KB\))] TJ ET BT 26.250 148.814 Td /F4 12.0 Tf [(APPENDIX 2)] TJ ET BT 26.250 111.662 Td /F4 12.0 Tf [(PRISMA Checklist)] TJ ET 0.267 0.267 0.267 rg BT 26.250 91.707 Td /F1 9.8 Tf [(Download PDF)] TJ ET 0.271 0.267 0.267 rg BT 91.809 91.707 Td /F1 9.8 Tf [( \(85KB\))] TJ ET BT 26.250 55.105 Td /F4 12.0 Tf [(References)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(6)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 525 0 obj << /Type /Annot /Subtype /Link /A 526 0 R /Border [0 0 0] /H /I /Rect [ 291.2355 543.3009 300.8728 552.1192 ] >> endobj 526 0 obj << /Type /Action >> endobj 527 0 obj << /Type /Annot /Subtype /Link /A 528 0 R /Border [0 0 0] /H /I /Rect [ 300.8728 543.3009 310.5102 552.1192 ] >> endobj 528 0 obj << /Type /Action >> endobj 529 0 obj << /Type /Annot /Subtype /Link /A 530 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 184.5143 91.8090 194.4349 ] >> endobj 530 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/disasters/files/2012/09/Table-2.-Articles-included-in-systematic-literature-review-7.27.12.pdf) >> endobj 531 0 obj << /Type /Annot /Subtype /Link /A 532 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 90.8056 91.8090 100.7262 ] >> endobj 532 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/disasters/files/2012/12/2.1.1-PRISMA-Checklist-Claver-etal.pdf) >> endobj 533 0 obj << /Type /Annot /Subtype /Link /A 534 0 R /Border [0 0 0] /H /I /Rect [ 291.2355 543.3009 300.8728 552.1192 ] >> endobj 534 0 obj << /Type /Action >> endobj 535 0 obj << /Type /Annot /Subtype /Link /A 536 0 R /Border [0 0 0] /H /I /Rect [ 300.8728 543.3009 310.5102 552.1192 ] >> endobj 536 0 obj << /Type /Action >> endobj 537 0 obj << /Type /Annot /Subtype /Link /A 538 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 184.5143 91.8090 194.4349 ] >> endobj 538 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/disasters/files/2012/09/Table-2.-Articles-included-in-systematic-literature-review-7.27.12.pdf) >> endobj 539 0 obj << /Type /Annot /Subtype /Link /A 540 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 90.8056 91.8090 100.7262 ] >> endobj 540 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/disasters/files/2012/12/2.1.1-PRISMA-Checklist-Claver-etal.pdf) >> endobj 541 0 obj << /Type /Annot /Subtype /Link /A 542 0 R /Border [0 0 0] /H /I /Rect [ 291.2355 543.3009 300.8728 552.1192 ] >> endobj 542 0 obj << /Type /Action >> endobj 543 0 obj << /Type /Annot /Subtype /Link /A 544 0 R /Border [0 0 0] /H /I /Rect [ 300.8728 543.3009 310.5102 552.1192 ] >> endobj 544 0 obj << /Type /Action >> endobj 545 0 obj << /Type /Annot /Subtype /Link /A 546 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 184.5143 91.8090 194.4349 ] >> endobj 546 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/disasters/files/2012/09/Table-2.-Articles-included-in-systematic-literature-review-7.27.12.pdf) >> endobj 547 0 obj << /Type /Annot /Subtype /Link /A 548 0 R /Border [0 0 0] /H /I /Rect [ 26.2500 90.8056 91.8090 100.7262 ] >> endobj 548 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/disasters/files/2012/12/2.1.1-PRISMA-Checklist-Claver-etal.pdf) >> endobj 549 0 obj << /Type /Page /Parent 3 0 R /Contents 550 0 R >> endobj 550 0 obj << /Length 21982 >> stream 0.271 0.267 0.267 rg q 15.000 37.477 577.500 739.523 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 759.976 Td /F1 9.8 Tf [(Denzin NK, Lincoln YS. Handbook of Qualitative Research \(2nd ed.\). Thousand Oaks, CA: Sage 2000.)] TJ ET BT 26.250 740.571 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 740.571 Td /F1 9.8 Tf [(Copeland LA, Fletcher CE, Patterson JE. Veterans health and access to care in the year after September 11, 2001. Mil Med )] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(2005;170\(7\):602-606.)] TJ ET BT 26.250 709.262 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 709.262 Td /F1 9.8 Tf [(Rosenheck R, Fontana A. Use of mental health services by veterans with PTSD after the terrorist attacks of September 11. )] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(Am J Psychiatry 2003b;160\(9\):1684-1690.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 677.952 Td /F1 9.8 Tf [(Rosenheck RA, Fontana A. Post-September 11 admission symptoms and treatment response among veterans with )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(posttraumatic stress disorder. Psychiatr Serv 2003a;54\(12\):1610-1617.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 646.643 Td /F1 9.8 Tf [(Druss BG, Henderson KL, Rosenheck RA. Swept away: use of general medical and mental health services among veterans )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(displaced by Hurricane Katrina. Am J Psychiatry 2007;164\(1\):154-156.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 615.333 Td /F1 9.8 Tf [(Niles BL, Wolf ALB, Kutter, CJ. Posttraumatic stress disorder symptomology in Vietnam Veterans before and after )] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(September 11. The Journal of Nervous and Mental Disease 2003:191\(10\):682-684.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 584.024 Td /F1 9.8 Tf [(Rosen C, Tiet Q, Cavella S, et al. Chronic PTSD patients functioning before and after the September 11 attacks. J Trauma )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(Stress 2005;18\(6\):781-784.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 552.714 Td /F1 9.8 Tf [(Krinsley KE, Gallagher JG, Weathers FW, et al. Consistency of retrospective reporting about exposure to traumatic events. J )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(Trauma Stress 2003;16\(4\):399-409.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 521.405 Td /F1 9.8 Tf [(Reeves RR, Liberto V. Reactions of Veterans Administration psychiatric patients to the September 2001 terrorist attacks. )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(South Med J 2001;94\(11\):1139.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Green BL, Lindy JD, Grace MC, et al. Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(sample. J Nerv ment Dis 1992;180\(12\):760-766.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Tharp, AT, Vasterling, JJ, Sullivan G, et al. Effects of pre- and post-Katrina nonviolent and violent experiences on male )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(veterans psychological functioning. Disaster Med Public Health Preparedness 2011;5:S227-S234.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Constans JI, Vasterling JJ, Deitch E, et al. Pre-Katrina mental illness, postdisaster negative cognitions, and PTSD )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(symptoms in male veterans following Hurricane Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published )] TJ ET BT 26.250 403.667 Td /F1 9.8 Tf [(Online First: 5 March 2012. doi: 10.1037/a0027487)] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 384.262 Td /F1 9.8 Tf [(Dobalian A, Stein JA, Heslin KC, et al. Impact of the Northridge earthquake on the mental health of veterans: Results from a )] TJ ET BT 26.250 372.357 Td /F1 9.8 Tf [(panel study. Disaster Med Public Health Preparedness 2011;5:S220-S226.)] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 352.953 Td /F1 9.8 Tf [(Davis TD, Sullivan G, Vasterling JJ, et al. Racial variations in postdisaster PTSD among veteran survivors of Hurricane )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published Online First: 7 November 2011. doi: )] TJ ET BT 26.250 329.143 Td /F1 9.8 Tf [(10.1037/a0025501)] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 309.738 Td /F1 9.8 Tf [(Lafuente CR, Eichaker V, Chee VE, et al. Post-Katrina provision of health care to veterans in a mobile clinic: providers )] TJ ET BT 26.250 297.834 Td /F1 9.8 Tf [(perspectives. J Am Acad Nurse Pract 2007;19\(8\):383-391.)] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 278.429 Td /F1 9.8 Tf [(Weiss T, Weiss L, Teeter D, et al. Care provided by VA mobile clinic staff during Northridge earthquake relief. Prehosp )] TJ ET BT 26.250 266.524 Td /F1 9.8 Tf [(Disaster Med 1999;14\(3\):191-197.)] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 247.119 Td /F1 9.8 Tf [(Teeter DS. Illnesses and injuries reported at Disaster Application Centers following the 1994 Northridge earthquake. Mil )] TJ ET BT 26.250 235.215 Td /F1 9.8 Tf [(Med 1996;161\(9\):526-530.)] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 215.810 Td /F1 9.8 Tf [(Clark, MA. Rebuilding the past: Health care reform in post-Katrina Louisiana. Journal of Health Politics, Policy and Law )] TJ ET BT 26.250 203.905 Td /F1 9.8 Tf [(2010;35\(5\):743-769.)] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 184.500 Td /F1 9.8 Tf [(Jones JW, Kiefe CI. Anthrax attacks and practice patterns: A learning opportunity for health care systems. Qual Manag )] TJ ET BT 26.250 172.596 Td /F1 9.8 Tf [(Health Care 2002;10\(3\):31-39.)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 153.191 Td /F1 9.8 Tf [(Potash MN, West JA, Corrigan S, et al. Pain management after Hurricane Katrina: Outcomes of veterans enrolled in a New )] TJ ET BT 26.250 141.286 Td /F1 9.8 Tf [(Orleans VA pain management program. Pain Med 2009;10\(3\):440-446)] TJ ET BT 26.250 121.881 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 121.881 Td /F1 9.8 Tf [(Fonseca VA, Smith H, Kuhadiya N, et al. Impact of a natural disaster on diabetes: Exacerbation of disparities and long-term )] TJ ET BT 26.250 109.977 Td /F1 9.8 Tf [(consequences. Diabetes Care 2009;32:16321638.)] TJ ET BT 26.250 90.572 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 90.572 Td /F1 9.8 Tf [(Hogan TP, Holmes SA, Rapacki LM, et al. Disaster preparedness and response practices among providers from the )] TJ ET BT 26.250 78.667 Td /F1 9.8 Tf [(Veterans Health Administration and Veterans with spinal cord injuries and/or disorders. J Spinal Cord Med 2011;34\(4\):353-361.)] TJ ET BT 26.250 59.262 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 59.262 Td /F1 9.8 Tf [(Leonard RB, Stringer LW, Alson R. Patient-data collection system used during medical operations after the 1994 San )] TJ ET BT 26.250 47.358 Td /F1 9.8 Tf [(Fernando Valley-Northridge earthquake. Prehosp Disaster Med 1995;10\(3\):178-183.)] TJ ET Q q 15.000 37.477 577.500 739.523 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 759.976 Td /F1 9.8 Tf [(Denzin NK, Lincoln YS. Handbook of Qualitative Research \(2nd ed.\). Thousand Oaks, CA: Sage 2000.)] TJ ET BT 26.250 740.571 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 740.571 Td /F1 9.8 Tf [(Copeland LA, Fletcher CE, Patterson JE. Veterans health and access to care in the year after September 11, 2001. Mil Med )] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(2005;170\(7\):602-606.)] TJ ET BT 26.250 709.262 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 709.262 Td /F1 9.8 Tf [(Rosenheck R, Fontana A. Use of mental health services by veterans with PTSD after the terrorist attacks of September 11. )] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(Am J Psychiatry 2003b;160\(9\):1684-1690.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 677.952 Td /F1 9.8 Tf [(Rosenheck RA, Fontana A. Post-September 11 admission symptoms and treatment response among veterans with )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(posttraumatic stress disorder. Psychiatr Serv 2003a;54\(12\):1610-1617.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 646.643 Td /F1 9.8 Tf [(Druss BG, Henderson KL, Rosenheck RA. Swept away: use of general medical and mental health services among veterans )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(displaced by Hurricane Katrina. Am J Psychiatry 2007;164\(1\):154-156.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 615.333 Td /F1 9.8 Tf [(Niles BL, Wolf ALB, Kutter, CJ. Posttraumatic stress disorder symptomology in Vietnam Veterans before and after )] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(September 11. The Journal of Nervous and Mental Disease 2003:191\(10\):682-684.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 584.024 Td /F1 9.8 Tf [(Rosen C, Tiet Q, Cavella S, et al. Chronic PTSD patients functioning before and after the September 11 attacks. J Trauma )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(Stress 2005;18\(6\):781-784.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 552.714 Td /F1 9.8 Tf [(Krinsley KE, Gallagher JG, Weathers FW, et al. Consistency of retrospective reporting about exposure to traumatic events. J )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(Trauma Stress 2003;16\(4\):399-409.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 521.405 Td /F1 9.8 Tf [(Reeves RR, Liberto V. Reactions of Veterans Administration psychiatric patients to the September 2001 terrorist attacks. )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(South Med J 2001;94\(11\):1139.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Green BL, Lindy JD, Grace MC, et al. Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(sample. J Nerv ment Dis 1992;180\(12\):760-766.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Tharp, AT, Vasterling, JJ, Sullivan G, et al. Effects of pre- and post-Katrina nonviolent and violent experiences on male )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(veterans psychological functioning. Disaster Med Public Health Preparedness 2011;5:S227-S234.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Constans JI, Vasterling JJ, Deitch E, et al. Pre-Katrina mental illness, postdisaster negative cognitions, and PTSD )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(symptoms in male veterans following Hurricane Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published )] TJ ET BT 26.250 403.667 Td /F1 9.8 Tf [(Online First: 5 March 2012. doi: 10.1037/a0027487)] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 384.262 Td /F1 9.8 Tf [(Dobalian A, Stein JA, Heslin KC, et al. Impact of the Northridge earthquake on the mental health of veterans: Results from a )] TJ ET BT 26.250 372.357 Td /F1 9.8 Tf [(panel study. Disaster Med Public Health Preparedness 2011;5:S220-S226.)] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 352.953 Td /F1 9.8 Tf [(Davis TD, Sullivan G, Vasterling JJ, et al. Racial variations in postdisaster PTSD among veteran survivors of Hurricane )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published Online First: 7 November 2011. doi: )] TJ ET BT 26.250 329.143 Td /F1 9.8 Tf [(10.1037/a0025501)] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 309.738 Td /F1 9.8 Tf [(Lafuente CR, Eichaker V, Chee VE, et al. Post-Katrina provision of health care to veterans in a mobile clinic: providers )] TJ ET BT 26.250 297.834 Td /F1 9.8 Tf [(perspectives. J Am Acad Nurse Pract 2007;19\(8\):383-391.)] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 278.429 Td /F1 9.8 Tf [(Weiss T, Weiss L, Teeter D, et al. Care provided by VA mobile clinic staff during Northridge earthquake relief. Prehosp )] TJ ET BT 26.250 266.524 Td /F1 9.8 Tf [(Disaster Med 1999;14\(3\):191-197.)] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 247.119 Td /F1 9.8 Tf [(Teeter DS. Illnesses and injuries reported at Disaster Application Centers following the 1994 Northridge earthquake. Mil )] TJ ET BT 26.250 235.215 Td /F1 9.8 Tf [(Med 1996;161\(9\):526-530.)] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 215.810 Td /F1 9.8 Tf [(Clark, MA. Rebuilding the past: Health care reform in post-Katrina Louisiana. Journal of Health Politics, Policy and Law )] TJ ET BT 26.250 203.905 Td /F1 9.8 Tf [(2010;35\(5\):743-769.)] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 184.500 Td /F1 9.8 Tf [(Jones JW, Kiefe CI. Anthrax attacks and practice patterns: A learning opportunity for health care systems. Qual Manag )] TJ ET BT 26.250 172.596 Td /F1 9.8 Tf [(Health Care 2002;10\(3\):31-39.)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 153.191 Td /F1 9.8 Tf [(Potash MN, West JA, Corrigan S, et al. Pain management after Hurricane Katrina: Outcomes of veterans enrolled in a New )] TJ ET BT 26.250 141.286 Td /F1 9.8 Tf [(Orleans VA pain management program. Pain Med 2009;10\(3\):440-446)] TJ ET BT 26.250 121.881 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 121.881 Td /F1 9.8 Tf [(Fonseca VA, Smith H, Kuhadiya N, et al. Impact of a natural disaster on diabetes: Exacerbation of disparities and long-term )] TJ ET BT 26.250 109.977 Td /F1 9.8 Tf [(consequences. Diabetes Care 2009;32:16321638.)] TJ ET BT 26.250 90.572 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 90.572 Td /F1 9.8 Tf [(Hogan TP, Holmes SA, Rapacki LM, et al. Disaster preparedness and response practices among providers from the )] TJ ET BT 26.250 78.667 Td /F1 9.8 Tf [(Veterans Health Administration and Veterans with spinal cord injuries and/or disorders. J Spinal Cord Med 2011;34\(4\):353-361.)] TJ ET BT 26.250 59.262 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 59.262 Td /F1 9.8 Tf [(Leonard RB, Stringer LW, Alson R. Patient-data collection system used during medical operations after the 1994 San )] TJ ET BT 26.250 47.358 Td /F1 9.8 Tf [(Fernando Valley-Northridge earthquake. Prehosp Disaster Med 1995;10\(3\):178-183.)] TJ ET Q q 15.000 37.477 577.500 739.523 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 759.976 Td /F1 9.8 Tf [(Denzin NK, Lincoln YS. Handbook of Qualitative Research \(2nd ed.\). Thousand Oaks, CA: Sage 2000.)] TJ ET BT 26.250 740.571 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 740.571 Td /F1 9.8 Tf [(Copeland LA, Fletcher CE, Patterson JE. Veterans health and access to care in the year after September 11, 2001. Mil Med )] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(2005;170\(7\):602-606.)] TJ ET BT 26.250 709.262 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 709.262 Td /F1 9.8 Tf [(Rosenheck R, Fontana A. Use of mental health services by veterans with PTSD after the terrorist attacks of September 11. )] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(Am J Psychiatry 2003b;160\(9\):1684-1690.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 677.952 Td /F1 9.8 Tf [(Rosenheck RA, Fontana A. Post-September 11 admission symptoms and treatment response among veterans with )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(posttraumatic stress disorder. Psychiatr Serv 2003a;54\(12\):1610-1617.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 646.643 Td /F1 9.8 Tf [(Druss BG, Henderson KL, Rosenheck RA. Swept away: use of general medical and mental health services among veterans )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(displaced by Hurricane Katrina. Am J Psychiatry 2007;164\(1\):154-156.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 615.333 Td /F1 9.8 Tf [(Niles BL, Wolf ALB, Kutter, CJ. Posttraumatic stress disorder symptomology in Vietnam Veterans before and after )] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(September 11. The Journal of Nervous and Mental Disease 2003:191\(10\):682-684.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 584.024 Td /F1 9.8 Tf [(Rosen C, Tiet Q, Cavella S, et al. Chronic PTSD patients functioning before and after the September 11 attacks. J Trauma )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(Stress 2005;18\(6\):781-784.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 552.714 Td /F1 9.8 Tf [(Krinsley KE, Gallagher JG, Weathers FW, et al. Consistency of retrospective reporting about exposure to traumatic events. J )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(Trauma Stress 2003;16\(4\):399-409.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 521.405 Td /F1 9.8 Tf [(Reeves RR, Liberto V. Reactions of Veterans Administration psychiatric patients to the September 2001 terrorist attacks. )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(South Med J 2001;94\(11\):1139.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Green BL, Lindy JD, Grace MC, et al. Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(sample. J Nerv ment Dis 1992;180\(12\):760-766.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Tharp, AT, Vasterling, JJ, Sullivan G, et al. Effects of pre- and post-Katrina nonviolent and violent experiences on male )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(veterans psychological functioning. Disaster Med Public Health Preparedness 2011;5:S227-S234.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Constans JI, Vasterling JJ, Deitch E, et al. Pre-Katrina mental illness, postdisaster negative cognitions, and PTSD )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(symptoms in male veterans following Hurricane Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published )] TJ ET BT 26.250 403.667 Td /F1 9.8 Tf [(Online First: 5 March 2012. doi: 10.1037/a0027487)] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 384.262 Td /F1 9.8 Tf [(Dobalian A, Stein JA, Heslin KC, et al. Impact of the Northridge earthquake on the mental health of veterans: Results from a )] TJ ET BT 26.250 372.357 Td /F1 9.8 Tf [(panel study. Disaster Med Public Health Preparedness 2011;5:S220-S226.)] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 352.953 Td /F1 9.8 Tf [(Davis TD, Sullivan G, Vasterling JJ, et al. Racial variations in postdisaster PTSD among veteran survivors of Hurricane )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Katrina. Psych Trauma: Theory, Research, Practice, and Policy. Published Online First: 7 November 2011. doi: )] TJ ET BT 26.250 329.143 Td /F1 9.8 Tf [(10.1037/a0025501)] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 309.738 Td /F1 9.8 Tf [(Lafuente CR, Eichaker V, Chee VE, et al. Post-Katrina provision of health care to veterans in a mobile clinic: providers )] TJ ET BT 26.250 297.834 Td /F1 9.8 Tf [(perspectives. J Am Acad Nurse Pract 2007;19\(8\):383-391.)] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 278.429 Td /F1 9.8 Tf [(Weiss T, Weiss L, Teeter D, et al. Care provided by VA mobile clinic staff during Northridge earthquake relief. Prehosp )] TJ ET BT 26.250 266.524 Td /F1 9.8 Tf [(Disaster Med 1999;14\(3\):191-197.)] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 247.119 Td /F1 9.8 Tf [(Teeter DS. Illnesses and injuries reported at Disaster Application Centers following the 1994 Northridge earthquake. Mil )] TJ ET BT 26.250 235.215 Td /F1 9.8 Tf [(Med 1996;161\(9\):526-530.)] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 215.810 Td /F1 9.8 Tf [(Clark, MA. Rebuilding the past: Health care reform in post-Katrina Louisiana. Journal of Health Politics, Policy and Law )] TJ ET BT 26.250 203.905 Td /F1 9.8 Tf [(2010;35\(5\):743-769.)] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 184.500 Td /F1 9.8 Tf [(Jones JW, Kiefe CI. Anthrax attacks and practice patterns: A learning opportunity for health care systems. Qual Manag )] TJ ET BT 26.250 172.596 Td /F1 9.8 Tf [(Health Care 2002;10\(3\):31-39.)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 153.191 Td /F1 9.8 Tf [(Potash MN, West JA, Corrigan S, et al. Pain management after Hurricane Katrina: Outcomes of veterans enrolled in a New )] TJ ET BT 26.250 141.286 Td /F1 9.8 Tf [(Orleans VA pain management program. Pain Med 2009;10\(3\):440-446)] TJ ET BT 26.250 121.881 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 121.881 Td /F1 9.8 Tf [(Fonseca VA, Smith H, Kuhadiya N, et al. Impact of a natural disaster on diabetes: Exacerbation of disparities and long-term )] TJ ET BT 26.250 109.977 Td /F1 9.8 Tf [(consequences. Diabetes Care 2009;32:16321638.)] TJ ET BT 26.250 90.572 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 90.572 Td /F1 9.8 Tf [(Hogan TP, Holmes SA, Rapacki LM, et al. Disaster preparedness and response practices among providers from the )] TJ ET BT 26.250 78.667 Td /F1 9.8 Tf [(Veterans Health Administration and Veterans with spinal cord injuries and/or disorders. J Spinal Cord Med 2011;34\(4\):353-361.)] TJ ET BT 26.250 59.262 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 59.262 Td /F1 9.8 Tf [(Leonard RB, Stringer LW, Alson R. Patient-data collection system used during medical operations after the 1994 San )] TJ ET BT 26.250 47.358 Td /F1 9.8 Tf [(Fernando Valley-Northridge earthquake. Prehosp Disaster Med 1995;10\(3\):178-183.)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(7)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET Q endstream endobj 551 0 obj << /Type /Page /Parent 3 0 R /Annots [ 553 0 R 555 0 R 557 0 R ] /Contents 552 0 R >> endobj 552 0 obj << /Length 20191 >> stream 0.271 0.267 0.267 rg q 15.000 96.869 577.500 680.131 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 759.976 Td /F1 9.8 Tf [(Brown SH, Fischetti LF, Graham G, et al. Use of electronic health records in disaster response: the experience of )] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Department of Veterans Affairs after Hurricane Katrina. Am J Public Health 2007;97 Suppl 1:S136-141.)] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 728.667 Td /F1 9.8 Tf [(Russum M. Responding to Katrina: A Veterans Affairs pharmacists experience. Am J Health Syst Pharm 2006;63\(9\):809-)] TJ ET BT 26.250 716.762 Td /F1 9.8 Tf [(810.)] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 697.357 Td /F1 9.8 Tf [(Blaser MJ, Ellison RT 3rd. Rapid nighttime evacuation of a veterans hospital. J Emerg Med 1985;3\(5\):387-394.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 677.952 Td /F1 9.8 Tf [(Chavez CW, Binder B. A hospital as victim and responder: the Sepulveda VA Medical Center and the Northridge )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(earthquake. J Emerg Med 1996;14\(4\):445-154.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(28.)] TJ ET BT 43.553 646.643 Td /F1 9.8 Tf [(Geraci SA, Douglas S, Algood TL, et al. Hurricane Katrina: the Jackson Veterans Affairs Medical Center experience. Am J )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(Med Sci 2008;336\(2\):116-123.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(29.)] TJ ET BT 43.553 615.333 Td /F1 9.8 Tf [(Fisher HL. Emergency Evacuation of the Denver Veterans Administration Medical Center. Military Medicine 1986:151:154-)] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(161.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(30.)] TJ ET BT 43.553 584.024 Td /F1 9.8 Tf [(Dobalian A, Claver M, Fickel JJ. Hurricanes Katrina and Rita and the Department of Veterans Affairs: A conceptual model )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(for understanding the evacuation of nursing homes. Gerontology 2010;56:581-588.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 552.714 Td /F1 9.8 Tf [(Lucero CA, Oda G, Cox K, et al. Enhanced health event detection and influenza surveillance using a joint Veterans Affairs )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(and Department of Defense biosurveillance application. BMC Med Infor and Decision Making 2011;11:56.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(32.)] TJ ET BT 43.553 521.405 Td /F1 9.8 Tf [(Lurie N, Dausey DJ, Knighton T, et al. Community planning for pandemic influenza: lessons from the VA health care )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(system. Disaster Med Public Health Prep 2008;2\(4\): 251-257.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(33.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Sokolow LZ, Grady N, Rolka H, et al. Deciphering data anomalies in BioSense. MMWR Morb Mortal Wkly Rep 2005;54 )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(Suppl:133-139.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(34.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Knapp KK, Okamoto MP, Black BL. ASHP survey of ambulatory care pharmacy practice in health systems 2004. Am J )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(Health Syst Pharm 2005;62\(3\):274-284.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(35.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Locatelli SM, LaVela SL, Hogan TP, et al. Communication and information sharing at VA facilities during the 2009 novel )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(H1N1 influenza pandemic. Am J Infection Control Published Online First 5 June 2012. doi:10.1016/j.ajic.2012.01.035)] TJ ET BT 26.250 396.167 Td /F1 9.8 Tf [(36.)] TJ ET BT 43.553 396.167 Td /F1 9.8 Tf [(Bradley CA, Rolka H, Walker D, et al. BioSense: implementation of a national early event detection and situational )] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(awareness system. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl: 11-19.)] TJ ET BT 26.250 364.857 Td /F1 9.8 Tf [(37.)] TJ ET BT 43.553 364.857 Td /F1 9.8 Tf [(Schult TM, Awosika R, Hodgon MJ, et al. 2009 influenza pandemic impact on sick leave use in the Veterans Health )] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(Administration: Framework for a health care provider-based national syndromic surveillance system. Disaster Med Public Health )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Preparedness 2011;5:S235-241.)] TJ ET BT 26.250 321.643 Td /F1 9.8 Tf [(38.)] TJ ET BT 43.553 321.643 Td /F1 9.8 Tf [(Schirmer P, Lucero C, Oda G, et al. Effective detection of the 2009 H1N1 influenza pandemic in U.S. Veterans Affairs )] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(medical centers using a national electronic biosurveillance system. PLoS ONE 2010;5\(3\):1-9.)] TJ ET BT 26.250 290.334 Td /F1 9.8 Tf [(39.)] TJ ET BT 43.553 290.334 Td /F1 9.8 Tf [(Brown M, Beatty J, OKeefe S, et al. Planning for hospital emergency mass-casualty decontamination by the US )] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(Department of Veterans Affairs. Disaster Manag Response 2004;2\(3\):75-80.)] TJ ET BT 26.250 259.024 Td /F1 9.8 Tf [(40.)] TJ ET BT 43.553 259.024 Td /F1 9.8 Tf [(Santos SL, Helmer DA, Fotiades J, et al. Developing a bioterrorism preparedness campaign for veterans: Using focus )] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(groups to inform materials development. Health Promot Pract 2007;8\(1\):31-40.)] TJ ET BT 26.250 227.715 Td /F1 9.8 Tf [(41.)] TJ ET BT 43.553 227.715 Td /F1 9.8 Tf [(Leidholdt EM Jr. William GE, McGuire LE. A reassessment of radioactive material security in health care and biomedical )] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(research. Health Phys 2003;85\(2 Suppl\): S15-19.)] TJ ET BT 26.250 196.405 Td /F1 9.8 Tf [(42.)] TJ ET BT 43.553 196.405 Td /F1 9.8 Tf [(Dobalian A, Callis R, Davey VJ. Evolution of the Veterans Health Administrations role in emergency management since )] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(September 11, 2001. Disaster Med Public Health Preparedness 2011;5\(suppl.2\):S182-S184.)] TJ ET BT 26.250 165.096 Td /F1 9.8 Tf [(43.)] TJ ET BT 43.553 165.096 Td /F1 9.8 Tf [(The Cochrane Collaboration. Evidence Aid Project. Accessed December 3, 2012 at: http://www.cochrane.org/cochrane-)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(reviews/evidence-aid-project)] TJ ET 0.267 0.267 0.267 rg BT 26.250 144.705 Td /F1 7.5 Tf [(REFERENCE LINK)] TJ ET 0.271 0.267 0.267 rg BT 26.250 126.155 Td /F1 9.8 Tf [(44.)] TJ ET BT 43.553 126.155 Td /F1 9.8 Tf [(Clarke M, Kayabu B. Evidence for disaster risk reduction, planning and response: design of the Evidence Aid survey. PLoS )] TJ ET BT 26.250 114.250 Td /F1 9.8 Tf [(Currents: Disasters 2011;3:RRN1270.)] TJ ET Q q 15.000 96.869 577.500 680.131 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 759.976 Td /F1 9.8 Tf [(Brown SH, Fischetti LF, Graham G, et al. Use of electronic health records in disaster response: the experience of )] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Department of Veterans Affairs after Hurricane Katrina. Am J Public Health 2007;97 Suppl 1:S136-141.)] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 728.667 Td /F1 9.8 Tf [(Russum M. Responding to Katrina: A Veterans Affairs pharmacists experience. Am J Health Syst Pharm 2006;63\(9\):809-)] TJ ET BT 26.250 716.762 Td /F1 9.8 Tf [(810.)] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 697.357 Td /F1 9.8 Tf [(Blaser MJ, Ellison RT 3rd. Rapid nighttime evacuation of a veterans hospital. J Emerg Med 1985;3\(5\):387-394.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 677.952 Td /F1 9.8 Tf [(Chavez CW, Binder B. A hospital as victim and responder: the Sepulveda VA Medical Center and the Northridge )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(earthquake. J Emerg Med 1996;14\(4\):445-154.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(28.)] TJ ET BT 43.553 646.643 Td /F1 9.8 Tf [(Geraci SA, Douglas S, Algood TL, et al. Hurricane Katrina: the Jackson Veterans Affairs Medical Center experience. Am J )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(Med Sci 2008;336\(2\):116-123.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(29.)] TJ ET BT 43.553 615.333 Td /F1 9.8 Tf [(Fisher HL. Emergency Evacuation of the Denver Veterans Administration Medical Center. Military Medicine 1986:151:154-)] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(161.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(30.)] TJ ET BT 43.553 584.024 Td /F1 9.8 Tf [(Dobalian A, Claver M, Fickel JJ. Hurricanes Katrina and Rita and the Department of Veterans Affairs: A conceptual model )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(for understanding the evacuation of nursing homes. Gerontology 2010;56:581-588.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 552.714 Td /F1 9.8 Tf [(Lucero CA, Oda G, Cox K, et al. Enhanced health event detection and influenza surveillance using a joint Veterans Affairs )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(and Department of Defense biosurveillance application. BMC Med Infor and Decision Making 2011;11:56.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(32.)] TJ ET BT 43.553 521.405 Td /F1 9.8 Tf [(Lurie N, Dausey DJ, Knighton T, et al. Community planning for pandemic influenza: lessons from the VA health care )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(system. Disaster Med Public Health Prep 2008;2\(4\): 251-257.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(33.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Sokolow LZ, Grady N, Rolka H, et al. Deciphering data anomalies in BioSense. MMWR Morb Mortal Wkly Rep 2005;54 )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(Suppl:133-139.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(34.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Knapp KK, Okamoto MP, Black BL. ASHP survey of ambulatory care pharmacy practice in health systems 2004. Am J )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(Health Syst Pharm 2005;62\(3\):274-284.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(35.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Locatelli SM, LaVela SL, Hogan TP, et al. Communication and information sharing at VA facilities during the 2009 novel )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(H1N1 influenza pandemic. Am J Infection Control Published Online First 5 June 2012. doi:10.1016/j.ajic.2012.01.035)] TJ ET BT 26.250 396.167 Td /F1 9.8 Tf [(36.)] TJ ET BT 43.553 396.167 Td /F1 9.8 Tf [(Bradley CA, Rolka H, Walker D, et al. BioSense: implementation of a national early event detection and situational )] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(awareness system. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl: 11-19.)] TJ ET BT 26.250 364.857 Td /F1 9.8 Tf [(37.)] TJ ET BT 43.553 364.857 Td /F1 9.8 Tf [(Schult TM, Awosika R, Hodgon MJ, et al. 2009 influenza pandemic impact on sick leave use in the Veterans Health )] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(Administration: Framework for a health care provider-based national syndromic surveillance system. Disaster Med Public Health )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Preparedness 2011;5:S235-241.)] TJ ET BT 26.250 321.643 Td /F1 9.8 Tf [(38.)] TJ ET BT 43.553 321.643 Td /F1 9.8 Tf [(Schirmer P, Lucero C, Oda G, et al. Effective detection of the 2009 H1N1 influenza pandemic in U.S. Veterans Affairs )] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(medical centers using a national electronic biosurveillance system. PLoS ONE 2010;5\(3\):1-9.)] TJ ET BT 26.250 290.334 Td /F1 9.8 Tf [(39.)] TJ ET BT 43.553 290.334 Td /F1 9.8 Tf [(Brown M, Beatty J, OKeefe S, et al. Planning for hospital emergency mass-casualty decontamination by the US )] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(Department of Veterans Affairs. Disaster Manag Response 2004;2\(3\):75-80.)] TJ ET BT 26.250 259.024 Td /F1 9.8 Tf [(40.)] TJ ET BT 43.553 259.024 Td /F1 9.8 Tf [(Santos SL, Helmer DA, Fotiades J, et al. Developing a bioterrorism preparedness campaign for veterans: Using focus )] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(groups to inform materials development. Health Promot Pract 2007;8\(1\):31-40.)] TJ ET BT 26.250 227.715 Td /F1 9.8 Tf [(41.)] TJ ET BT 43.553 227.715 Td /F1 9.8 Tf [(Leidholdt EM Jr. William GE, McGuire LE. A reassessment of radioactive material security in health care and biomedical )] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(research. Health Phys 2003;85\(2 Suppl\): S15-19.)] TJ ET BT 26.250 196.405 Td /F1 9.8 Tf [(42.)] TJ ET BT 43.553 196.405 Td /F1 9.8 Tf [(Dobalian A, Callis R, Davey VJ. Evolution of the Veterans Health Administrations role in emergency management since )] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(September 11, 2001. Disaster Med Public Health Preparedness 2011;5\(suppl.2\):S182-S184.)] TJ ET BT 26.250 165.096 Td /F1 9.8 Tf [(43.)] TJ ET BT 43.553 165.096 Td /F1 9.8 Tf [(The Cochrane Collaboration. Evidence Aid Project. Accessed December 3, 2012 at: http://www.cochrane.org/cochrane-)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(reviews/evidence-aid-project)] TJ ET 0.267 0.267 0.267 rg BT 26.250 144.705 Td /F1 7.5 Tf [(REFERENCE LINK)] TJ ET 0.271 0.267 0.267 rg BT 26.250 126.155 Td /F1 9.8 Tf [(44.)] TJ ET BT 43.553 126.155 Td /F1 9.8 Tf [(Clarke M, Kayabu B. Evidence for disaster risk reduction, planning and response: design of the Evidence Aid survey. PLoS )] TJ ET BT 26.250 114.250 Td /F1 9.8 Tf [(Currents: Disasters 2011;3:RRN1270.)] TJ ET Q q 15.000 96.869 577.500 680.131 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 759.976 Td /F1 9.8 Tf [(Brown SH, Fischetti LF, Graham G, et al. Use of electronic health records in disaster response: the experience of )] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Department of Veterans Affairs after Hurricane Katrina. Am J Public Health 2007;97 Suppl 1:S136-141.)] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 728.667 Td /F1 9.8 Tf [(Russum M. Responding to Katrina: A Veterans Affairs pharmacists experience. Am J Health Syst Pharm 2006;63\(9\):809-)] TJ ET BT 26.250 716.762 Td /F1 9.8 Tf [(810.)] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 697.357 Td /F1 9.8 Tf [(Blaser MJ, Ellison RT 3rd. Rapid nighttime evacuation of a veterans hospital. J Emerg Med 1985;3\(5\):387-394.)] TJ ET BT 26.250 677.952 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 677.952 Td /F1 9.8 Tf [(Chavez CW, Binder B. A hospital as victim and responder: the Sepulveda VA Medical Center and the Northridge )] TJ ET BT 26.250 666.048 Td /F1 9.8 Tf [(earthquake. J Emerg Med 1996;14\(4\):445-154.)] TJ ET BT 26.250 646.643 Td /F1 9.8 Tf [(28.)] TJ ET BT 43.553 646.643 Td /F1 9.8 Tf [(Geraci SA, Douglas S, Algood TL, et al. Hurricane Katrina: the Jackson Veterans Affairs Medical Center experience. Am J )] TJ ET BT 26.250 634.738 Td /F1 9.8 Tf [(Med Sci 2008;336\(2\):116-123.)] TJ ET BT 26.250 615.333 Td /F1 9.8 Tf [(29.)] TJ ET BT 43.553 615.333 Td /F1 9.8 Tf [(Fisher HL. Emergency Evacuation of the Denver Veterans Administration Medical Center. Military Medicine 1986:151:154-)] TJ ET BT 26.250 603.429 Td /F1 9.8 Tf [(161.)] TJ ET BT 26.250 584.024 Td /F1 9.8 Tf [(30.)] TJ ET BT 43.553 584.024 Td /F1 9.8 Tf [(Dobalian A, Claver M, Fickel JJ. Hurricanes Katrina and Rita and the Department of Veterans Affairs: A conceptual model )] TJ ET BT 26.250 572.119 Td /F1 9.8 Tf [(for understanding the evacuation of nursing homes. Gerontology 2010;56:581-588.)] TJ ET BT 26.250 552.714 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 552.714 Td /F1 9.8 Tf [(Lucero CA, Oda G, Cox K, et al. Enhanced health event detection and influenza surveillance using a joint Veterans Affairs )] TJ ET BT 26.250 540.810 Td /F1 9.8 Tf [(and Department of Defense biosurveillance application. BMC Med Infor and Decision Making 2011;11:56.)] TJ ET BT 26.250 521.405 Td /F1 9.8 Tf [(32.)] TJ ET BT 43.553 521.405 Td /F1 9.8 Tf [(Lurie N, Dausey DJ, Knighton T, et al. Community planning for pandemic influenza: lessons from the VA health care )] TJ ET BT 26.250 509.500 Td /F1 9.8 Tf [(system. Disaster Med Public Health Prep 2008;2\(4\): 251-257.)] TJ ET BT 26.250 490.095 Td /F1 9.8 Tf [(33.)] TJ ET BT 43.553 490.095 Td /F1 9.8 Tf [(Sokolow LZ, Grady N, Rolka H, et al. Deciphering data anomalies in BioSense. MMWR Morb Mortal Wkly Rep 2005;54 )] TJ ET BT 26.250 478.191 Td /F1 9.8 Tf [(Suppl:133-139.)] TJ ET BT 26.250 458.786 Td /F1 9.8 Tf [(34.)] TJ ET BT 43.553 458.786 Td /F1 9.8 Tf [(Knapp KK, Okamoto MP, Black BL. ASHP survey of ambulatory care pharmacy practice in health systems 2004. Am J )] TJ ET BT 26.250 446.881 Td /F1 9.8 Tf [(Health Syst Pharm 2005;62\(3\):274-284.)] TJ ET BT 26.250 427.476 Td /F1 9.8 Tf [(35.)] TJ ET BT 43.553 427.476 Td /F1 9.8 Tf [(Locatelli SM, LaVela SL, Hogan TP, et al. Communication and information sharing at VA facilities during the 2009 novel )] TJ ET BT 26.250 415.572 Td /F1 9.8 Tf [(H1N1 influenza pandemic. Am J Infection Control Published Online First 5 June 2012. doi:10.1016/j.ajic.2012.01.035)] TJ ET BT 26.250 396.167 Td /F1 9.8 Tf [(36.)] TJ ET BT 43.553 396.167 Td /F1 9.8 Tf [(Bradley CA, Rolka H, Walker D, et al. BioSense: implementation of a national early event detection and situational )] TJ ET BT 26.250 384.262 Td /F1 9.8 Tf [(awareness system. MMWR Morb Mortal Wkly Rep. 2005; 54 Suppl: 11-19.)] TJ ET BT 26.250 364.857 Td /F1 9.8 Tf [(37.)] TJ ET BT 43.553 364.857 Td /F1 9.8 Tf [(Schult TM, Awosika R, Hodgon MJ, et al. 2009 influenza pandemic impact on sick leave use in the Veterans Health )] TJ ET BT 26.250 352.953 Td /F1 9.8 Tf [(Administration: Framework for a health care provider-based national syndromic surveillance system. Disaster Med Public Health )] TJ ET BT 26.250 341.048 Td /F1 9.8 Tf [(Preparedness 2011;5:S235-241.)] TJ ET BT 26.250 321.643 Td /F1 9.8 Tf [(38.)] TJ ET BT 43.553 321.643 Td /F1 9.8 Tf [(Schirmer P, Lucero C, Oda G, et al. Effective detection of the 2009 H1N1 influenza pandemic in U.S. Veterans Affairs )] TJ ET BT 26.250 309.738 Td /F1 9.8 Tf [(medical centers using a national electronic biosurveillance system. PLoS ONE 2010;5\(3\):1-9.)] TJ ET BT 26.250 290.334 Td /F1 9.8 Tf [(39.)] TJ ET BT 43.553 290.334 Td /F1 9.8 Tf [(Brown M, Beatty J, OKeefe S, et al. Planning for hospital emergency mass-casualty decontamination by the US )] TJ ET BT 26.250 278.429 Td /F1 9.8 Tf [(Department of Veterans Affairs. Disaster Manag Response 2004;2\(3\):75-80.)] TJ ET BT 26.250 259.024 Td /F1 9.8 Tf [(40.)] TJ ET BT 43.553 259.024 Td /F1 9.8 Tf [(Santos SL, Helmer DA, Fotiades J, et al. Developing a bioterrorism preparedness campaign for veterans: Using focus )] TJ ET BT 26.250 247.119 Td /F1 9.8 Tf [(groups to inform materials development. Health Promot Pract 2007;8\(1\):31-40.)] TJ ET BT 26.250 227.715 Td /F1 9.8 Tf [(41.)] TJ ET BT 43.553 227.715 Td /F1 9.8 Tf [(Leidholdt EM Jr. William GE, McGuire LE. A reassessment of radioactive material security in health care and biomedical )] TJ ET BT 26.250 215.810 Td /F1 9.8 Tf [(research. Health Phys 2003;85\(2 Suppl\): S15-19.)] TJ ET BT 26.250 196.405 Td /F1 9.8 Tf [(42.)] TJ ET BT 43.553 196.405 Td /F1 9.8 Tf [(Dobalian A, Callis R, Davey VJ. Evolution of the Veterans Health Administrations role in emergency management since )] TJ ET BT 26.250 184.500 Td /F1 9.8 Tf [(September 11, 2001. Disaster Med Public Health Preparedness 2011;5\(suppl.2\):S182-S184.)] TJ ET BT 26.250 165.096 Td /F1 9.8 Tf [(43.)] TJ ET BT 43.553 165.096 Td /F1 9.8 Tf [(The Cochrane Collaboration. Evidence Aid Project. Accessed December 3, 2012 at: http://www.cochrane.org/cochrane-)] TJ ET BT 26.250 153.191 Td /F1 9.8 Tf [(reviews/evidence-aid-project)] TJ ET 0.267 0.267 0.267 rg BT 26.250 144.705 Td /F1 7.5 Tf [(REFERENCE LINK)] TJ ET 0.271 0.267 0.267 rg BT 26.250 126.155 Td /F1 9.8 Tf [(44.)] TJ ET BT 43.553 126.155 Td /F1 9.8 Tf [(Clarke M, Kayabu B. Evidence for disaster risk reduction, planning and response: design of the Evidence Aid survey. 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