The convergence of agreements on disaster risk reduction (DRR), development finance, sustainable development and climate change in 2015 presents a unique opportunity for coherence across these inter-related policy areas. At the same time, demand is growing for a more prominent and effective role for science and technology in providing evidence for policy, with the international community recognising that successful disaster risk reduction (DRR) depends on it. Reflecting this ambition, science is included as a core aspect of the Sendai Framework for Disaster Risk Reduction 2015-2030, although the ways in which this will be implemented in practice is still unclear. This paper aims to inform the implementation of international science coordination for DRR by examining a number of existing international science partnerships used across other relevant areas of policy to understand best practice, options for coordination and lessons identified. In the field of DRR, the science-policy interface needs to be strengthened in line with the best practice described in this review. An enhanced UNISDR Scientific and Technical Advisory Group will be given the mandate for to enhance the evidence base for DRR and mobilise science and technical work in coordination with a broad range of stakeholders. The structure and function of an enhanced STAG must be as open, as inclusive and as participatory as possible in order to build trust in new and existing institutions at local, national, regional and global levels. The challenge for the international community is to facilitate evidence-based policy making by formally recognising the links between DRR, development finance, sustainable development and climate change in the upcoming post-2015 agreements.

Background and purpose: Geoinformatics technology retains an unprecedented trait of performing with a supersonic speed and precision in public health management whereas the existing disease surveillance systems in developing countries lack using this technology. This article aims to assess the feasibility of using geoinformatics technology in disaster disease surveillance in a developing country, Iran.

Methods: A self-administered questionnaire was developed based on technology acceptance model (TAM), and a semi-quantitative survey was conducted in order to collect data. Fifty TUMS & HS personnel, currently involve in disease surveillance and information technology, were included. Initially, a pilot study was conducted to test the validity and reliability of the questionnaire. Cronbach alpha, confirmatory factor analysis (CFA), and standard error of measurement (SEM) were calculated to validate the causal model.

Results: The results from structural equation analysis suggested that TAM provided a constructive picture of using geoinformatics technology in disaster disease surveillance at TUMS &HS. The study found attitude (ATT) had a significant influence on participants intention to use (ITU) a new technology, and perceived ease of use (PEOU) was a strong determinant of perceived of usefulness (PU). Subsequently, PU and PEOU explained ATT substantially; even though the analysis showed insignificant statistical association among these constructs. The high R2 (Coefficient of determination) of the constructs described respondents positive instinct towards accepting a new technology.

Conclusion: The study reveals that personnel intent to adopt geoinformatics technology in disaster disease surveillance; and at the same time, they possess a positive attitude towards the technology. This study also found PEOU has a strong influence on PU, so information sessions and training on geoinformatics technology need to focus primarily on the applications and impacts of technology on disaster disease surveillance.

The health risks posed by heatwaves have been well documented. In the UK, before and during a heatwave, alerts are issued to the general public based on a tiered warning system integrating the use of colour and number sequences. There has of yet been no formal assessment of the public response to these messages. Cultural and language barriers make some members of ethnic minority communities particularly hard to reach. These may be less challenging amongst younger community members, who may be well placed to instigate the circulation of warning information to those less able or willing to use conventional channels.

This qualitative study assesses the role of age and ethnic and cultural background in the conceptualisation of the number and colour systems used as part of the Heat-Health Watch System (HHWS) and the National Severe Weather Warning Service (NSWWS). Young and older participants were recruited from the Bangladeshi and white British populations of Tower Hamlets. All participants were given a cognitive task that required them to identify and draw associations between 12 cards depicting the four colours and numbers used in the warning system and four pictures providing contextualisation in terms of heatwave risk. A qualitative analysis of the heuristics used in the group discussions provided insights into the conceptualisations basic to interpreting colour and number sequences as representations of risk graduations, and how interpretation might be influenced by age and ethnic and cultural background.

There were considerable differences in the interpretation of young Bangladeshi and older white British participants, on the one hand, and older Bangladeshi participants, on the other. Young Bangladeshis and older white British participants conceptualised the colours and numbers as a vertical scale, with the numbers/colours at “the top” corresponding to representations of higher temperature. This conceptualisation was mainly based on strong associations between colour and temperature, with risk only associated with the upper limit of the scale. Older Bangladeshi participants, on the other hand, conceptualised the numbers and pictures as a narrative sequence and disassociated the colours from the other cards. The differences between groups suggest potential cultural barriers to the “intended” interpretation of the colour and number sequences for older Bangladeshis but not for young Bangladeshis. The fact that the predominant association for the colour sequence for both young Bangladeshis and older white British participants was with graduations of temperature rather than risk raises questions about the applicability of using colours in a tiered warning system.

Background: Mass gatherings including a large number of people makes the planning and management of the event a difficult task. Kumbh Mela is one such, internationally famous religious mass gathering. It creates the substantial challenge of creating a temporary city in which millions of people can stay for a defined period of time. The arrangements need to allow this very large number of people to reside with proper human waste disposal, medical services, adequate supplies of food and clean water, transportation etc.

Methods: We report a case study of Maha Kumbh, 2013 which focuses on the management and planning that went into the preparation of Kumbh Mela and understanding its water, sanitation and hygiene conditions. It was an observational cross-sectional study, the field work was done for 13 days, from 21 January to 2 February 2013.

Results: Our findings suggest that the Mela committee and all other agencies involved in Mela management proved to be successful in supervising the event and making it convenient, efficient and safe. Health care services and water sanitation and hygiene conditions were found to be satisfactory. BhuleBhatke Kendra (Center for helping people who got separated from their families) had the major task of finding missing people and helping them to meet their families. Some of the shortfalls identified were that drainage was a major problem and some fire incidents were reported. Therefore, improvement in drainage facilities and reduction in fire incidents are essential to making Mela cleaner and safer. The number of persons per toilet was high and there were no separate toilets for males and females. Special facilities and separate toilets for men and women will improve their stay in Mela.

Conclusion: Inculcation of modern methods and technologies are likely to help in supporting crowd management and improving water, sanitation and hygiene conditions in the continuously expanding KumbhMela, in the coming years.

Introduction: Recent years have witnessed community disaster resilience becoming one of the most heavily supported and advocated approach to disaster risk management. However, its application has been influenced by the lack of assessment tools. This study reviews studies conducted using the resilience concept and examines the tools, models, and methods adopted. It examines the domains, indicators, and indices have been considered in the tools. It provides a critical analysis of the assessment tools available for evaluating community disaster resilience (CDR).

Methods: We investigated international electronic databases including Scopus, MEDLINE through PubMed, ISI Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health (CINAHL), and Google Scholar with no limitation on date, and type of articles. The search terms and strategy were as follow: (Disaster* OR Emergenc*) AND (Resilience OR Resilient OR Resiliency) that were applied for titles, abstracts and keywords. Extracted data were analyzed in terms of studied hazards, types of methodology, domains, and indicators of CDR assessment.

Results: Of 675 publications initially identified, the final analysis was conducted on 17 full text articles. These studies presented ten models, tools, or indices for CDR assessment. These evinced a diverse set of models with regard to the domains, indicators and the kind of hazard described. Considerable inter dependency between and among domains and indicators also emerged from this analysis.

Conclusion: The disparity between the articles using the resilience concept and those that offer some approach to measurement (675 vs. 17) indicates the conceptual and measurement complexity in CDR and the fact that the concept may be being used without regard to how CDR should be operationalized and assessed. Of those that have attempted to assess CDR, the level of conceptual diversity indicates limited agreement about how to operationalize the concept. As a way forward we summarize the models identified in the literature and suggest that, as a starting point for the systematic operationalization of CDR, that existing indicators of community disaster resilience be classified in five domains. These are social, economic, institutional, physical and natural domains. A need to use appropriate and effective methods to quantify and weigh them with regard to their relative contributions to resilience is identified, as is a need to consider how these levels interrelate to influence resilience. Although assessment of disaster resilience especially at the community level will inform disaster risk reduction strategies, attempts to systematically do so are in preliminary phases. Further empirical investigation is needed to develop a operational and measurable CDR model.

Introduction: Effectiveness of hospital management of disasters requires a well-defined and rehearsed system. The Hospital Incident Command System (HICS), as a standardized method for command and control, was established in Iranian hospitals, but it has performed fairly during disaster exercises. This paper describes the process for, and modifications to HICS undertaken to optimize disaster management in hospitals in Iran. Methods: In 2013, a group of 11 subject matter experts participated in an expert consensus modified Delphi to develop modifications to the 2006 version of HICS. Results: The following changes were recommended by the expert panel and subsequently implemented: 1) A Quality Control Officer was added to the Command group; 2) Security was defined as a new section; 3) Infrastructure and Business Continuity Branches were moved from the Operations Section to the Logistics and the Administration Sections, respectively; and 4) the Planning Section was merged within the Finance/Administration Section. Conclusion: An expert consensus group developed a modified HICS that is more feasible to implement given the managerial organization of hospitals in Iran. This new model may enhance hospital performance in managing disasters. Additional studies are needed to test the feasibility and efficacy of the modified HICS in Iran, both during simulations and actual disasters. This process may be a useful model for other countries desiring to improve disaster incident management systems for their hospitals.

Background: Surgical capacity assessments in low-income countries have demonstrated critical deficiencies. Though vital for planning capacity improvements, these assessments are resource intensive and impractical during the planning phase of a humanitarian crisis. This study aimed to determine cesarean sections to total operations performed (CSR) and emergency herniorrhaphies to all herniorrhaphies performed (EHR) ratios from Médecins Sans Frontières Operations Centre Brussels (MSF-OCB) projects and examine if these established metrics are useful proxies for surgical capacity in low-income countries affected by crisis.

Methods: All procedures performed in MSF-OCB operating theatres from July 2008 through June 2014 were reviewed. Projects providing only specialty care, not fully operational or not offering elective surgeries were excluded. Annual CSRs and EHRs were calculated for each project. Their relationship was assessed with linear regression.

Results: After applying the exclusion criteria, there were 47,472 cases performed at 13 sites in 8 countries. There were 13,939 CS performed (29% of total cases). Of the 4,632 herniorrhaphies performed (10% of total cases), 30% were emergency procedures. CSRs ranged from 0.06 to 0.65 and EHRs ranged from 0.03 to 1.0. Linear regression of annual ratios at each project did not demonstrate statistical evidence for the CSR to predict EHR [F(2,30)=2.34, p=0.11, R2=0.11]. The regression equation was: EHR = 0.25 + 0.52(CSR) + 0.10(reason for MSF-OCB assistance).

Conclusion: Surgical humanitarian assistance projects operate in areas with critical surgical capacity deficiencies that are further disrupted by crisis. Rapid, accurate assessments of surgical capacity are necessary to plan cost- and clinically-effective humanitarian responses to baseline and acute unmet surgical needs in LICs affected by crisis. Though CSR and EHR may meet these criteria in ‘steady-state’ healthcare systems, they may not be useful during humanitarian emergencies. Further study of the relationship between direct surgical capacity improvements and these ratios is necessary to document their role in humanitarian settings.

Between April and June 2014, International Orthodox Christian Charities (IOCC), an International NGO, and the Greek Orthodox Patriarchate of Antioch and All the East (GOPA) conducted a needs assessment of Syrians affected by the crisis with the objective of gaining a better understanding of humanitarian needs and assistance priorities. Findings suggest that interventions that increase access to non-food items, food, medication and education should be prioritized where cost was the primary barrier to accessing goods and services. Cash transfer programs and direct provision of material assistance should be considered, though the most appropriate assistance modality is likely to vary by sector, location and the preferences and prior experience of donors and implementing organizations. Renewed international commitment to funding humanitarian assistance efforts in Syria and neighboring countries where the burden of refugees is greatest is essential from both a human rights perspective and in terms of maintaining stability in the region.

Background: This study aimed to identify the indices and frameworks that have been used to assess the performance of communicable disease surveillance (CDS) in response to disasters and other emergencies, including infectious disease outbreaks.

Method: In this systematic review, PubMed, Google Scholar, Scopus, ScienceDirect, ProQuest databases and grey literature were searched until the end of 2013. All retrieved titles were examined in accordance with inclusion criteria. Abstracts of the relevant titles were reviewed and eligible abstracts were included in a list for data abstraction. Finally, the study variables were extracted.

Results: Sixteen articles and one book were found relevant to our study objectives. In these articles, 31 criteria and 35 indicators were used or suggested for the assessment/evaluation of the performance of surveillance systems in disasters. The Centers for Disease Control (CDC) updated guidelines for the evaluation of public health surveillance systems were the most widely used.

Conclusion: Despite the importance of performance assessment in improving CDS in response to disasters, there is a lack of clear and accepted frameworks. There is also no agreement on the use of existing criteria and indices. The only relevant framework is the CDC guideline, which is a common framework for assessing public health surveillance systems as a whole. There is an urgent need to develop appropriate frameworks, criteria, and indices for specifically assessing the performance of CDS in response to disasters and other emergencies, including infectious diseases outbreaks.

Key words: Disasters, Emergencies, Communicable Diseases, Surveillance System, Performance Assessment

Objectives: In this survey, we aimed to build consensus and gather opinions on ‘Kokoro-no care’ or mental health services and psychosocial support (MHSPSS) after a disaster, among mental health professionals who engaged in care after the Great East Japan Earthquake.

Methods: We recruited mental health professionals who engaged in support activities after the Great East Japan Earthquake, which included local health professionals in the affected areas and members of mental health care teams dispatched from outside (n = 131). Adopting the Delphi process, we proposed a definition of ‘Kokoro-no care’, and asked the participants to rate the appropriateness on a 5-point Likert scale. We also solicited free comments based on the participants’ experiences during the disaster. After Round 1, we presented the summary statistics and comments, and asked the participants to re-rate the definition that had been modified based on their comments. This process was repeated twice, until the consensus criterion of ≥ 80% of the participants scoring ≥ 4 on the statement was fulfilled.

Results: In Round 1, 68.7% of the respondents rated the proposed definition ≥ 4 for its appropriateness, and 88.4% did so in Round 2. The comments were grouped into categories (and subcategories) based on those related to the definition in general (Appropriate, Continuum of MHSPSS, Cautions in operation, Alternative categorisation of care components, Whether the care component should be categorised according to the professional involved, Ambiguous use of psychology, and Others), to mental health services (Appropriate, More specification within mental health services, More explicit remarks on mental health services, and Others), and to psychosocial support (Whether the care component should be categorised according to the professional involved, Raising concerns about the terms, and Others), and others.

Conclusion: We achieved a consensus on the definition of ‘Kokoro-no care’, and systematically obtained suggestions on the concept, and practical advice on operation, based on the participants’ experiences from the Great East Japan Earthquake. This collective knowledge will serve as reference to prepare and respond to future disasters.

Background: The management of large animals during disasters and emergencies creates difficult operational environments for responders. The aims of this study were to identify the exact challenges faced by Australian emergency response personnel in their interactions with large animals and their owners, and to determine the readiness for large animal rescue (LAR) in Australia.

Methods: A survey tool collected the views and experiences of a broad cross section of emergency services personnel operating across Australia and across all hazards. Data were collected from 156 responders including Australian emergency services personnel, emergency managers such as federal agricultural departments, and local government.

Results: Overall, many of the respondents had serious concerns, and felt that there were significant issues in relation to LAR in Australia. These included the coordination of emergency care for animals, physical management of large animals, inter-agency coordination, and dealing with animal owners. Very few respondents had received any formal training in LAR, with an overwhelming majority indicating they would attend formal training if it were made available.

Discussion: Results help to guide the development of evidence-informed support tools to assist operational response and community engagement, and the production of professional development resources.

Introduction: This paper describes how American federal, state, and local organizations created, sourced, and disseminated emergency information via social media in preparation for several winter storms in one county in the state of New Jersey (USA).

Methods: Postings submitted to Twitter for three winter storm periods were collected from selected organizations, along with a purposeful sample of select private local users. Storm-related posts were analyzed for stylistic features (hashtags, retweet mentions, embedded URLs). Sharing and re-tweeting patterns were also mapped using NodeXL.

Results: Results indicate emergency management entities were active in providing preparedness and response information during the selected winter weather events. A large number of posts, however, did not include unique Twitter features that maximize dissemination and discovery by users. Visual representations of interactions illustrate opportunities for developing stronger relationships among agencies.

Discussion: Whereas previous research predominantly focuses on large-scale national or international disaster contexts, the current study instead provides needed analysis in a small-scale context. With practice during localized events like extreme weather, effective information dissemination in large events can be enhanced.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction: Data from an electronic medical record (EMR) system can provide valuable insight regarding health consequences in the aftermath of a disaster. In January of 2010, the U.S. Department of Health and Human Services (HHS) deployed medical personnel to Haiti in response to a crippling earthquake. An EMR system was used to record patient encounters in real-time and to provide data for decision support during response activities.

Problem: During the Haiti response, HHS monitored the EMR system by recoding diagnoses into seven broad categories. At the conclusion of the response, it was evident that a new diagnosis categorization process was needed to provide a better description of the patient encounters that were seen in the field. After examining the EMRs, researchers determined nearly half of the medical records were missing diagnosis data. The objective of this study was to develop and test a new method of categorization for patient encounters to provide more detailed data for decision making.

Methods: A single researcher verified or assigned a new diagnosis for 8,787 EMRs created during the Haiti response. This created a new variable, the Operational Code, which was based on available diagnosis data and chief complaint. Retrospectively, diagnoses recorded in the field and Operational Codes were categorized into eighteen categories based on the ICD-9-CM diagnostic system.

Results: Creating an Operational Code variable led to a more robust data set and a clearer depiction emerged of the clinical presentations seen at six HHS clinics set up in the aftermath of Haiti’s earthquake. The number of records with an associated ICD-9 code increased 106% from 4,261 to 8,787. The most frequent Operational Code categories during the response were: General Symptoms, Signs, and Ill-Defined Conditions (34.2%), Injury and Poisoning (18.9%), Other (14.7%), Respiratory (4.8%), and Musculoskeletal and Connective Tissue (4.8%).

Conclusion: The Operational Code methodology provided more detailed data about patient encounters. This methodology could be used in future deployments to improve situational awareness and decision-making capabilities during emergency response operations.

Introduction: A disaster is a serious disruption to the functioning of a community that exceeds its capacity to cope within its own resources. Risk communication in disasters aims to prevent and mitigate harm from disasters, prepare the population before a disaster, disseminate information during disasters and aid subsequent recovery. The aim of this systematic review is to identify, appraise and synthesise the findings of studies of the effects of risk communication interventions during four stages of the disaster cycle.
Methods: We searched the Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PsycInfo, Sociological Abstracts, Web of Science and grey literature sources for randomised trials, cluster randomised trials, controlled and uncontrolled before and after studies, interrupted time series studies and qualitative studies of any method of disaster risk communication to at-risk populations. Outcome criteria were disaster-related knowledge and behaviour, and health outcomes.
Results: Searches yielded 5,224 unique articles, of which 100 were judged to be potentially relevant. Twenty-five studies met the inclusion criteria, and two additional studies were identified from other searching. The studies evaluated interventions in all four stages of the disaster cycle, included a variety of man-made, natural and infectious disease disasters, and were conducted in many disparate settings. Only one randomised trial and one cluster randomised trial were identified, with less robust designs used in the other studies. Several studies reported improvements in disaster-related knowledge and behaviour.
Discussion: We identified and appraised intervention studies of disaster risk communication and present an overview of the contemporary literature. Most studies used non-randomised designs that make interpretation challenging. We do not make specific recommendations for practice but highlight the need for high-quality randomised trials and appropriately-analysed cluster randomised trials in the field of disaster risk communication where these can be conducted within an appropriate research ethics framework.

Introduction:
As a result of the gaps in humanitarian response highlighted by several reports, the international community called for an increased professionalization of humanitarian aid workers. This paper describes a pilot project by an Italian university and a non-profit, non-governmental organization to implement a medical apprenticeship in low-income countries during Anesthesia and Intensive Care Medicine residencies.

Methods:
Before deployment, participants were required to complete a dedicated online training course about safety and security in the field, principles of anesthesia at the district hospital level, emergency and essential surgical care, essentials of medical treatment in resource-constrained environments and psychological support in emergencies.

Results:
At the end of the program, a qualitative self-evaluation questionnaire administered to participants highlighted how the project allowed the participants to advance their professional skills when working in a low-resource environment, while also mastering their adapting skills and the ability to interact and cooperate with local healthcare personnel. The project also proved to be a means for personal growth, making these experiences a recommendation for all residents as a necessary step for the professionalization of healthcare personnel involved in humanitarian aid.