During a mass casualty disaster, the acute imbalance between need for treatment and capacity to supply care poses difficult rationing problems. It is common to assume that such disasters call for “utilitarian” procedures that deliberately prioritize saving the most lives over other considerations. A group of medical responders to the 2010 Haitian earthquake faced particular challenges in determining how to allocate limited treatment, time and other resources between existing patients and potential patients not yet under care. We identified that rationing dilemmas points occurred at three points: when care had to be limited, when care had to be completed prematurely, and when care had to be withdrawn. “Repeat triage” refers to rationing challenges occurring at all these points, where the allocation of care is between existing and potential patients. By contrast, “initial triage” designates the allocation of access to treatment among new arrivals, all of whom are potential patients.

Repeat and initial triage differ significantly. Several considerations make repeat triage special by supporting limited priority to existing patients, in transgression of pure “utilitarian” procedures: (1) Pragmatically, often it is more efficient to complete treatment on existing patients, for whom prognosis can be established with greater certainty and without added time, than to attempt to save new patients; (2) A fiduciary trust relationship has been formed between care-giver and existing patients, which may make the moral obligation towards them somewhat stronger than the one to potential patients; (3) Existing patients will have often arrived earlier, so when needs are equal, the “first come, first served” principle prioritizes them for care; (4) Withdrawal of care during repeat triage may constitute active rather than passive harm, and more often a serious transgression of patient autonomy; (5) Health providers should normally not be asked to behave in ways that profoundly violate their personal and professional integrity, and abandoning existing patients may do so. For these reasons, responders can permissibly give a degree of priority to existing patients over newcomers in disaster.

The 2010 Pakistan flood affected 20 million people. The impact of the event and recovery is measured at 6 months.
Methods: Cross-sectional cluster survey of 1769 households conducted six months post-flood in 29 most-affected districts. The outcome measures were physical damage, flood-related death and illness and changes in income, access to electricity, clean water and sanitation facilities.
Results: Households were headed by males, large and poor. The flood destroyed 54.8% of homes and caused 86.8% households to move, with 46.9% living in an IDP camp. Lack of electricity increased from 18.8% to 32.9% (p = 0.000), lack of toilet facilities from 29.0% to 40.4% (p=0.000). Access to protected water remained unchanged (96.8%); however, the sources changed (p=0.000). 88.0% reported loss of income (90.0% rural, 75.0% urban, p=0.000) with rural households loosing significantly more and less likely to recovered. Immediate deaths and injuries were uncommon but 77.0% reported flood-related illnesses. Significant differences were noted between urban and rural as well as gender and education of the head of houshold.
Discussion: After 6 months, much of the population had not recovered their prior standard of living or access to services. Rural households were more commonly impacted and slower to recover. Targeting relief to high-risk populations including rural, female-headed and those with lower education is needed.

Citation: Kirsch TD, Wadhwani C, Sauer L, Doocy S, Catlett C. Impact of the 2010 Pakistan Floods on Rural and Urban Populations at Six Months. PLOS Currents Disasters. 2012 Aug 22. doi: 10.1371/4fdfb212d2432.

Introduction:
The fire and explosion of the Deepwater Horizon oil rig resulted in an enormous oil spill that threatened large distances of coastline. The overall response was led by the United States Coast Guard and involved the oil company BP, federal agencies, and state and local governments of five states.
Methods:
The Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health focused extensive resources on ensuring that BP and its contractors provided safe working conditions for thousands of workers involved in the response. Federal personnel visited worksites daily, identifying hazards and means of abatement; assessed training programs to ensure that workers were adequately trained in languages they could understand; monitored chemical exposures and determined that the proper personal protective equipment was deployed; insisted on implementation of a heat mitigation program; rostered thousands of workers; and conducted extensive outreach in communities impacted by the spill.
Results:
Advance planning, immediate deployment, and collaboration across agencies helped ensure that the response operations resulted in no worker fatalities, and relatively few injuries and illnesses.
Conclusions:
For future responses, improvements should be made in how safety and health information, as well as the process behind safety and health decisions, are communicated to the public.

Citation: Michaels D, Howard J. Review of the OSHA-NIOSH Response to the Deepwater Horizon Oil Spill: Protecting the Health and Safety of Cleanup Workers. PLoS Currents Disasters. 2012 Jul 18

Background: Construction of houses in homesteads and their settings occur in the context of traditional perceptions and practices in the rural culture of Bangladesh. Functional spaces inside and around the house are produced according to need over time. Inhabitants construct their houses with locally available resources and knowledge. After devastating disasters houses are delivered as products by the development agencies to quickly cater to the needs of the sufferers. The extreme poor are the receivers and inhabitants of these new houses, which can cause significant changes in the physical and environmental characteristics of the neighborhood. In this regard the building and dwelling values of the inhabitants in relation with these houses may be changed or lost. But these values are otherwise inherent characters of the rural houses in the habitations that are shaped by the aspirations of the dwellers.

Methods and Findings: This paper investigates how relief houses serve the needs of the extreme poor after disasters and how these houses gradually blend with the surrounding environment matching with the aspirations of the inhabitants. The methodology followed was observation of the backgrounds of the pre and post disaster situations, focus group discussions, drawings sessions and interviews with the inhabitants, craftsmen and locals, use of secondary sources, and visits to the houses during and after construction to understand the techniques and space value.

Conclusions: The present practice of distribution of relief houses without involvement of the owners either in the information sharing or building processes and without understanding owners’ perceptions about dwellings, may compromise the compatibility and hence the sustainability of relief houses. Hence, houses may only be used as temporary or transitional shelters to sustain life in the disaster phase, and will not be used as “houses” long term.

Background: In this paper we examine the role of collective action in assisting rural communities to cope with and adapt to environmental risks in Nepalgunj, Nepal and Krabi Province, Thailand. Drawing upon two case studies, we explore the role of collective action in building adaptive capacity, paying particular attention to the role of social networks.

Methods: Data for this paper was gathered using a range of different methods across the two different studies. In Nepal semi-structured interviews were conducted with a range of stakeholders in addition to participant observation and secondary data collection. In Thailand the researchers utilised a vulnerability assessment, participatory multi-stakeholder assessment, a detailed case study and an online dialogue.

Findings: We make three key observations: firstly, collective action plays a significant role in enhancing adaptive capacity and hence should be more strongly considered in the development of climate change adaptation strategies; secondly, social networks are a particularly important component of collective action for the building of adaptive capacity; and thirdly, the mandate, capacity, and structure of local government agencies can influence the effectiveness of collective action, both positively and negatively.

Conclusions: We argue that there is an urgent need for further consideration of the different forms of collective action within community-based disaster risk management and climate change adaptation.